[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1142 Introduced in House (IH)]







107th CONGRESS
  1st Session
                                H. R. 1142

   To amend title XIX of the Social Security Act to permit uninsured 
 individuals to obtain coverage under the Medicaid Program, to assure 
   coverage of prescription drugs, alcohol and drug abuse treatment 
 services, mental health services, long-term care services, and other 
                   services, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 21, 2001

Mr. Conyers (for himself, Mrs. Christensen, Mr. Bonior, and Mrs. Jones 
   of Ohio) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend title XIX of the Social Security Act to permit uninsured 
 individuals to obtain coverage under the Medicaid Program, to assure 
   coverage of prescription drugs, alcohol and drug abuse treatment 
 services, mental health services, long-term care services, and other 
                   services, 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.

    This Act may be cited as the ``Working American Families Access to 
Health Care Act of 2001'' or ``Medi-Access Act of 2001''.

SEC. 2. MEDI-ACCESS PROGRAM.

    (a) Availability of Medicaid Coverage for Uninsured Individual 
Under Medi-Access.--
            (1) Expansion to individuals with family income below 400 
        percent (or 600 percent in 2004) of poverty line without 
        applying any asset test.--
                    (A) In general.--Section 1902 of the Social 
                Security Act (42 U.S.C. 1396a) is amended--
                            (i) in subsection (a)(10)(A)(i)--
                                    (I) by striking ``or'' at the end 
                                of subclause (VI);
                                    (II) by striking the semicolon at 
                                the end of subclause (VII) and 
                                inserting ``, or''; and
                                    (III) by adding at the end the 
                                following new subclause:
                                    ``(VIII) described in subsection 
                                (cc);''; and
                            (ii) by adding at the end, as amended by 
                        section 2(a) of the Breast and Cervical Cancer 
                        Prevention and Treatment Act of 2000 (Public 
                        Law 106-354; 114 Stat. 1381) and section 702(b) 
                        of the Medicare, Medicaid, and SCHIP Benefits 
                        Improvement and Protection Act of 2000 (as 
                        enacted into law by section 1(a)(6) of Public 
                        Law 106-554), the following new subsection:
    ``(cc)(1) For purposes of (a)(10)(A)(i)(VIII), individuals 
described in this subsection are individuals who meet the following 
requirements:
            ``(A) Subject to paragraph (2), the income of the 
        individual's family does not exceed 400 percent (or, effective 
        January 1, 2004, 600 percent) of the poverty line (as defined 
        in section 2110(c)(5)) applicable to a family of the size 
        involved.
            ``(B) The individual is not otherwise described or covered 
        under this title under any other provision.
            ``(C) Subject to paragraph (2), the individual does not 
        have creditable coverage (described in section 2701(c)(1) of 
        the Public Health Service Act, but not taking into account 
        subparagraph (F) of that section or eligibility for benefits 
        under title XXI).
    ``(2) The requirements of subparagraphs (A) and (C) of paragraph 
(1) shall not apply in the case of an individual if it is clearly 
demonstrated with respect to that individual that--
            ``(A) the individual has a life threatening, or a severe 
        and debilitating, illness or injury; and
            ``(B)(i) any private health plan or health benefits 
        coverage under which the individual is covered will not cover 
        the illness or injury due to pre-existing condition policies, 
        or (ii) the individual or family member would pay excessively 
        high monthly premiums or out-of-pocket expenses if covered 
        under such a plan or coverage due to having such illness or 
        injury.
Eligibility under this paragraph shall be determined by the State on a 
case-by-case basis.
    ``(3) An individual who is described in this subsection is eligible 
for medical assistance without regard to the amount of the assets or 
resources of the individual or the individual's family.''.
                    (B) No premiums for individuals with income below 
                300 percent of poverty line; requiring premiums only 
                for individuals with higher income.--Section 1916 of 
                such Act (42 U.S.C. 1396o) is amended--
                            (i) in subsection (a), by striking 
                        ``Subject to subsection (g)'' and inserting 
                        ``Subject to subsections (g) and (h)''; and
                            (ii) by adding at the end the following new 
                        subsection:
    ``(h) With respect to an individual provided medical assistance 
only under subclause (VIII) of section 1902(a)(10)(A)(i), if the 
individual's family income--
            ``(1) does not exceed 300 percent of the poverty line (as 
        defined in section 2110(c)(5)) applicable to a family of the 
        size involved, a State shall not require payment of any monthly 
        premium;
            ``(2) exceeds 300 percent (but does not exceed 350 percent) 
        of such poverty line applicable to a family of the size 
        involved, a State shall require such individuals to pay a 
        monthly premium equal to $25 per month for each individual in 
        the family so covered, but not to exceed $100 per month for all 
        individuals in the family;
            ``(3) exceeds 350 percent (but does not exceed 400 percent) 
        of such poverty line, the State shall require such individuals 
        to pay a monthly premium equal to $50 per month for each 
        individual in the family so covered, but not to exceed $150 per 
        month for all individuals in the family; or
            ``(4) exceeds 400 percent of such poverty line, the State 
        shall require such individuals to pay a monthly premium equal 
        to $150 per month for each individual in the family so covered, 
        but not to exceed $450 per month for all individuals in the 
        family.
A State may enter into an arrangement with an employer that employs at 
least 2, but fewer than 51, employees under which the employer will pay 
directly for premiums established under this subsection. Nothing in 
this subsection shall be construed as authorizing the use of premiums 
collected under this subsection for vouchers for the purchase of 
private health insurance.''.
                    (C) Miscellaneous conforming amendment.--(i) 
                Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)) 
                is amended by inserting ``1902(a)(10)(A)(i)(VIII),'' 
                after ``1902(a)(10)(A)(i)(VII),''.
                    (D) Technical amendments.--(i) Section 1902 of such 
                Act (42 U.S.C. 1396a), as amended by section 702(b) of 
                the Medicare, Medicaid, and SCHIP Benefits Improvement 
                and Protection Act of 2000 (as enacted into law by 
                section 1(a)(6) of Public Law 106-554), is amended by 
                redesignating the subsection (aa) added by such section 
                as subsection (bb).
                    (ii) Section 1902(a)(15) of such Act (42 U.S.C. 
                1396a(a)(15)), as added by section 702(a)(2) of the 
                Medicare, Medicaid, and SCHIP Benefits Improvement and 
                Protection Act of 2000 (as so enacted into law), is 
                amended by striking ``subsection (aa)'' and inserting 
                ``subsection (bb)''.
                    (iii) Section 1915(b) of such Act (42 U.S.C. 
                1396n(b)), as amended by section 702(c)(2) of the 
                Medicare, Medicaid, and SCHIP Benefits Improvement and 
                Protection Act of 2000 (as so enacted into law), is 
                amended by striking ``1902(aa)'' and inserting 
                ``1902(bb)''.
            (2) Clarification of coverage of uninsured men and women, 
        regardless of marital status.--Section 1905(a) of such Act (42 
        U.S.C. 1396d(a)) is amended, in the matter before paragraph 
        (1)--
                    (A) by striking ``or'' at the end of clause (xi);
                    (B) by adding ``or'' at the end of clause (xii); 
                and
                    (C) by inserting after clause (xii) the following 
                new clause:
            ``(xiii) individuals described in section 1902(cc) (which 
        includes uninsured men and women, regardless of marital 
        status),''.
            (3) Making presumptive eligibility mandatory.--
                    (A) In general.--Sections 1920 and 1920A of such 
                Act (42 U.S.C. 1396r-1, 1396r-1a) are each amended by 
                striking ``may provide'' and inserting ``shall 
                provide''.
                    (B) Expansion of presumptive eligibility to all 
                individuals.--Title XIX of the Act is amended by 
                inserting after section 1920A the following new 
                section:

            ``presumptive eligibility for other individuals

    ``Sec. 1920B. (a) A State plan approved under section 1902 shall 
provide for making medical assistance with respect to health care items 
and services covered under the State plan available to all individuals 
during a presumptive eligibility period.
    ``(b) For purposes of this section:
            ``(1) The term `presumptive eligibility period' means, with 
        respect to an individual, the period that--
                    ``(A) begins with the date on which a qualified 
                entity determines, on the basis of preliminary 
                information, that the family income of the individual 
                does not exceed the applicable income level of 
                eligibility under the State plan, and
                    ``(B) ends with (and includes) the earlier of--
                            ``(i) the day on which a determination is 
                        made with respect to the eligibility of the 
                        individual for medical assistance under the 
                        State plan, or
                            ``(ii) in the case of an individual on 
                        whose behalf an application is not filed by the 
                        last day of the month following the month 
                        during which the entity makes the determination 
                        referred to in subparagraph (A), such last day.
            ``(3)(A) Subject to subparagraph (B), the term `qualified 
        entity' means any entity that--
                    ``(i)(I) is eligible for payments under a State 
                plan approved under this title and provides items and 
                services described in subsection (a) or (II) is a 
                qualified provider described in section 1920(b)(2); and
                    ``(ii) is determined by the State agency to be 
                capable of making determinations of the type described 
                in paragraph (1)(A).
            ``(B) The Secretary may issue regulations further limiting 
        those entities that may become qualified entities in order to 
        prevent fraud and abuse and for other reasons.
            ``(C) Nothing in this section shall be construed as 
        preventing a State from limiting the classes of entities that 
        may become qualified entities, consistent with any limitations 
        imposed under subparagraph (B).
    ``(c)(1) The State agency shall provide qualified entities with--
            ``(A) such forms as are necessary for an application to be 
        made on behalf of a child for medical assistance under the 
        State plan, and
            ``(B) information on how to assist parents, guardians, and 
        other persons in completing and filing such forms.
    ``(2) A qualified entity that determines under subsection (b)(1)(A) 
that an individual is presumptively eligible for medical assistance 
under a State plan shall--
            ``(A) notify the State agency of the determination within 5 
        working days after the date on which determination is made, and
            ``(B) inform the individual at the time the determination 
        is made that an application for medical assistance under the 
State plan is required to be made by not later than the last day of the 
month following the month during which the determination is made.
    ``(3) In the case of an individual who is determined by a qualified 
entity to be presumptively eligible for medical assistance under a 
State plan, the individual shall make application for medical 
assistance under such plan by not later than the last day of the month 
following the month during which the determination is made.
    ``(d) Notwithstanding any other provision of this title, medical 
assistance for items and services described in subsection (a) that--
            ``(1) are furnished to an individual--
                    ``(A) during a presumptive eligibility period,
                    ``(B) by an entity that is eligible for payments 
                under the State plan; and
            ``(2) are included in the care and services covered by a 
        State plan;
shall be treated as medical assistance provided by such plan for 
purposes of section 1903.''.
                    (C) Conforming amendment.--Section 1902(a)(47) of 
                such Act (42 U.S.C. 1396a(a)(47)) is amended by 
                striking ``at the option of the State,''.
            (4) Minimum eligibility period for categorically needy.--
        Section 1902(e) of such Act (42 U.S.C. 1396a(e)) is amended by 
        adding at the end the following new paragraph:
    ``(13) The State plan shall provide that an individual who is 
determined to be eligible for benefits under a State plan approved 
under this title under subsection (a)(10)(A) shall remain eligible for 
those benefits until the end of the 12-month period following the date 
of such determination.''.
            (5) Coverage of legal immigrants.--Section 1902 of such Act 
        (42 U.S.C. 1396a), as amended by paragraph (1)(A)(ii), is 
        amended by adding at the end the following new subsection:
    ``(dd) Notwithstanding any other provision of law, the provisions 
title IV of the Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996 (and of section 213A of the Immigration and 
Nationality Act) shall not apply to eligibility for medical assistance 
under this title for individuals who are lawful permanent residents of 
the United States.''.
            (6) Mail-in and on-line application process.--Section 
        1902(a)(8) of such Act (42 U.S.C. 1396a(a)(8)) is amended after 
        ``opportunity to do so'' the following: ``and may do so through 
        an application submitted by mail or through electronic means 
        through the Internet, provide that applications are not longer 
        than 3 pages and are made available in different languages in 
        order to provide a fair and accessible application process,''.
            (7) Conforming termination of schip.--With respect to items 
        and services furnished on or after October 1, 2002, no Federal 
        payments shall be made under section 2105(a) of the Social 
        Security Act (42 U.S.C. 1397ee(a)).
    (b) Requiring Coverage of Early and Periodic Screening, Diagnostic, 
and Treatment Services (EPSDT), Coverage of Rehabilitative Services for 
Disabled or Developmentally Delayed Children, Prescription Drugs, 
Mental Health and Psychiatric Services, Assistive Technology Devices 
and Services, Durable Medical Equipment, Drug and Alcohol Treatment 
Services for All Medicaid Eligible Individuals, Assistive Technology 
Devices and Services, Durable Medical Equipment, Prenatal and Postnatal 
Care, and Reproductive Health Services.--
            (1) Requiring coverage of screening, dental, vision, 
        hearing, and followup services (epsdt) for individuals of all 
        ages.--
                    (A) In general.--Section 1905(a)(4)(B) of such Act 
                (42 U.S.C. 1396d(a)(4)(B)) is amended by striking ``and 
                are under the age of 21''.
                    (B) Conforming amendments.--Section 1905(r) of such 
                Act (42 U.S.C. 1396d(r)) is amended, in each of 
                paragraphs (1)(A)(i), (2)(A)(i), (3)(A)(i), and 
                (4)(A)(i), by inserting ``, including for children, 
                organizations'' after ``organizations''.
            (2) Requiring coverage of rehabilitative services and 
        assistive technologies for disabled or developmentally delayed 
        children.--Section 1905(r)(5) of such Act (42 U.S.C. 
        1396d(r)(5)) is amended by inserting before the period at the 
        end the following: ``, and including rehabilitative services 
        and assistive technologies for disabled or developmentally 
        disabled children, regardless of whether the disability was 
        discovered by the screening services''.
            (3) Requiring coverage of prescription drugs.--Section 
        1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10)) is amended--
                    (A) in subparagraph (A), by inserting ``(12),'' 
                after ``(5),'';
                    (B) in subparagraph (D)(iv), by inserting ``, 
                (12),'' after ``(5)'';
                    (C) by striking ``and'' at the end of subparagraph 
                (F);
                    (D) by adding ``and'' at the end of subparagraph 
                (G); and
                    (E) by inserting after subparagraph (G) the 
                following new subparagraph:
                    ``(H) that the plan shall not deny medical 
                assistance for prescribed drugs for individuals 
                described in subparagraph (A)(i) if the drugs have been 
                prescribed by a treating physician (or any other 
                treating health care professional authorized under law 
                to prescribe the drugs);''.
            (4) Requiring coverage of drug and alcohol treatment 
        services.--
                    (A) Requirement.--Section 1902(a)(10) of such Act 
                (42 U.S.C. 1396a(a)(10)) is amended--
                            (i) in subparagraph (A), by striking ``(17) 
                        and (21)'' and inserting ``(10), (17), (21), 
                        and (27)''; and
                            (ii) in subparagraph (D)(iv), by striking 
                        ``and (17)'' and inserting ``(10), (17), and 
                        (27)'' and by striking ``through (24)'' and 
                        inserting ``through (27)''.
                    (B) Drug and alcohol treatment services 
                described.--Section 1905(a) of such Act (42 U.S.C. 
                1396d(a)) is amended--
                            (i) by striking ``and'' at the end of 
                        paragraph (26);
                            (ii) by redesignating paragraph (27) as 
                        paragraph (28); and
                            (iii) by inserting after paragraph (26) the 
                        following new paragraph:
            ``(27) alcohol and drug treatment services, including 
        coverage of inpatient and outpatient treatment without 
        durational restriction; and''.
            (5) Requiring coverage of inpatient and outpatient mental 
        health and psychiatric services.--Section 1905(a)(5) of such 
        Act (42 U.S.C. 1396d(a)(5)) is amended--
                    (A) by striking ``and'' before ``(B)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (C) mental health services and 
                psychiatric services furnished by a physician or other 
                qualified mental health professional, whether furnished 
                on an inpatient or outpatient basis''.
            (6) Requiring coverage of mental health services without 
        durational restriction.--Section 1902(a)(10) of such Act (42 
        U.S.C. 1396a(a)(10)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (F);
                    (B) by adding ``and'' at the end of subparagraph 
                (G); and
                    (C) by inserting after subparagraph (G) the 
                following new subparagraph:
                    ``(H) that does not impose durational limits with 
                respect to medical assistance for mental health 
                services;''.
            (7) Requiring coverage of some chiropractic services.--
        Section 1902(a)(10)(A) of such Act (42 U.S.C. 1396a(a)(10)(A)) 
        is amended, in the matter before clause (i), by inserting ``and 
        professional services of chiropractors (other than electrical 
        stimulation and for up to 2 visits per month)'' after ``(21) of 
        section 1905(a)''.
            (8) Requiring coverage of assistive technology devices and 
        services, durable medical equipment, sexually-transmitted 
        disease (std) diagnosis and treatment, and prenatal and post-
        natal care.--Section 1905(a)(3) of such Act (42 U.S.C. 
        1396d(a)(3)) is amended by inserting before the semicolon at 
        the end the following: ``, assistive technology devices and 
        services, durable medical equipment, diagnosis and treatment 
        for sexually-transmitted disease, and prenatal and postnatal 
        care''.
            (9) Requiring coverage of reproductive health services.--
        Section 1905(a)(4)(C) of such Act (42 U.S.C. 1396d(a)(4)(C)) is 
        amended by inserting ``, including reproductive health services 
        such as fertility drugs and contraceptives'' after ``such 
        services and supplies''.
    (c) FMAP.--
            (1) Federal assumption of increased expenses.--Section 1903 
        of such Act (42 U.S.C. 1396b) is amended by inserting after 
        subsection (g) the following new subsection:
    ``(h) Notwithstanding subsection (a), with respect to expenditures 
incurred under the plan which are attributable to additional 
populations, or services, covered as a result of the implementation of 
the amendments made by the Working American Families Access to Health 
Care Act of 2001 (including administrative costs related to such 
implementation), the percentages otherwise specified under such 
subsection with respect to such expenditures shall be increased to 100 
percent. For purposes of applying the previous sentence, the fact that 
a population or service was covered under this title under a waiver 
under section 1115 shall not be taken into account and shall not 
prevent such sentence applying to such population or service.''.
            (2) Special rules in applying to territories.--(A) Section 
        1905(b)(2) of such Act (42 U.S.C. 1396d(b)(2)) is amended by 
        striking ``50 percent'' and inserting ``70 percent''.
            (B) Section 1108 of such Act (42 U.S.C. 1308) is amended--
                    (i) in subsection (f), by striking ``subsection 
                (g)'' and inserting ``subsections (g) and (h)''; and
                    (ii) by adding at the end the following new 
                subsection:
    ``(h) The limitations under subsection (f)--
            ``(1) shall not apply with respect to expenditures 
        described in section 1903(h); and
            ``(2) with respect to other expenditures made for fiscal 
        years beginning with fiscal year 2002 with respect to a 
        territory shall be 250 percent of the amount otherwise 
        permitted under such subsection and subsection (g) with respect 
        to such territory.''.
    (d) State-Like Treatment of Territories.--Section 1108 of such Act 
(42 U.S.C. 1308) is amended--
            (1) in subsection (f), by striking ``subsection (g)'' and 
        inserting ``subsections (g) and (h)''; and
            (2) by adding at the end the following new subsection:
    ``(h) Exemption of Certain Expenditures From Limitation.--Amounts 
of expenditures attributable to medical assistance provided under 
section 1902(a)(10)(A)(i)(VIII) (or otherwise required to carry out the 
amendments made by the Working American Families Access to Health Care 
Act of 2001) shall not be taken into account in applying subsections 
(f) and (g).''.
    (e) Required Use of Community-Based Organizations in Expenditures 
for Outreach and Media.--Section 1903(i) of such Act (42 
U.S.C. 1396b(i)) is amended by inserting after paragraph (8) the 
following new paragraph:
            ``(9) with respect to amounts expended for outreach and 
        media education campaigns (including amounts expended for 
        assistance to those applying for medical assistance), unless at 
        least 25 percent of such amounts are made available for such 
        expenditures through community-based organizations; or''.
    (f) Floor for Medicaid HMO Payment for All Services.--Section 
1932(b) of such Act (42 U.S.C. 1396u-2(b)) is amended by adding at the 
end the following new paragraph:
            ``(9) Payment floor for all services.--A medicaid managed 
        care organization shall not reimburse a hospital or other 
        health care provider or professional for the provision of 
        services under this section at a rate that is less the fee-for-
        service rate provided by the State for payment for such a 
        hospital, provider, or professional for such services under 
        this title in the case of individuals who are not enrolled with 
        such an organization under this section.''.
    (g) Toll-Free Number.--Section 1902 of such Act (42 U.S.C. 1396a) 
is amended by inserting after subsection (j) the following new 
subsection:
    ``(k) The Secretary shall establish a toll-free telephone number at 
which individuals who are eligible for medical assistance under this 
title may file complaints concerning health care providers who do not 
accept medical assistance under this title for services they provide or 
concerning other problems they have with the program under this 
title.''.
    (h) Collection of Data by Race and Ethnicity.--The Secretary of 
Health and Human Services shall provide for the collection of data on 
enrollment, receipt of services, and health outcomes under the medicaid 
program under title XIX of the Social Security Act, broken down at 
least by the race and ethnicity of medicaid recipients. The Director of 
the Office of Management and Budget shall make such revisions in data 
collection standards as may be necessary to carry out this subsection.
    (i) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2002.
                                 <all>