[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 3179 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 3179

To amend the Public Health Service Act to provide health care coverage 
                       for qualified caregivers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 19, 2002

  Mr. Durbin introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to provide health care coverage 
                       for qualified caregivers.

    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 ``Caregivers Access to Health 
Insurance Act''.

SEC. 2. PURPOSES.

    It is the purpose of this Act to--
            (1) expand the availability of health insurance coverage to 
        those individuals involved in the worthy task of providing care 
        for the children, the disabled, and the elderly of the United 
        States;
            (2) provide incentives to attract and retain quality 
        caregivers; and
            (3) prevent those caring full-time for disabled or elderly 
        relatives from losing access to health insurance coverage.

SEC. 3. HEALTH CARE COVERAGE FOR CAREGIVERS

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

          ``TITLE XXVIII--HEALTH CARE COVERAGE FOR CAREGIVERS

``SEC. 2801. PURPOSE; STATE PLANS.

    ``(a) Purpose.--The purpose of this title is to provide funds to 
States to enable them to--
            ``(1) expand the availability of health insurance coverage 
        to those individuals involved in providing care for children, 
        the disabled, and the elderly; and
            (2) provide incentives to attract and retain quality 
        caregivers.
    ``(b) State Plan Required.--A State is not eligible for payment 
under section 2805 unless the State has submitted to the Secretary 
under section 2806 a plan that--
            ``(1) sets forth how the State intends to use the funds 
        provided under this title to provide health insurance or health 
        care assistance through title XIX of the Social Security Act, 
        or other State or local health care assistance or insurance 
        programs, or to provide assistance through the Federal 
        Employees Health Benefits Program if permitted under law, to 
        eligible caregivers consistent with the provisions of this 
        title, and
            ``(2) has been approved under section 2806.
    ``(c) State Entitlement.--This title constitutes budget authority 
in advance of appropriations Acts and represents the obligation of the 
Federal Government to provide for the payment to States of amounts 
provided under section 2804.
    ``(d) Effective Date.--No State is eligible for payments under 
section 2805 for health care assistance for coverage provided for 
periods beginning before October 1, 2001.

``SEC. 2802. GENERAL CONTENTS OF STATE PLAN; ELIGIBILITY; OUTREACH.

    ``(a) General Background and Description.--A State plan shall 
include a description, consistent with the requirements of this title, 
of--
            ``(1) the extent to which, and manner in which, eligible 
        caregivers in the State, currently have creditable health 
        coverage (as defined in section 2810(c)(2));
            ``(2) current State efforts to provide or obtain creditable 
        health coverage for eligible caregivers, including the steps 
        the State is taking to identify and enroll all such caregivers 
        who are eligible to participate in public health insurance 
        programs and health insurance programs that involve public-
        private partnerships;
            ``(3) how the plan is designed to be coordinated with such 
        efforts to increase coverage of such caregivers under 
        creditable health coverage;
            ``(4) the health care assistance provided under the plan 
        for eligible caregivers and the dependent children of such 
        caregivers, including the proposed methods of delivery, and 
        utilization control systems;
            ``(5) eligibility standards consistent with subsection (b);
            ``(6) outreach activities consistent with subsection (c); 
        and
            ``(7) methods (including monitoring) used--
                    ``(A) to assure the quality and appropriateness of 
                care provided under the plan, and
                    ``(B) to assure access to covered services, 
                including emergency services.
    ``(b) General Description of Eligibility Standards and 
Methodology.--
            ``(1) Eligibility standards.--
                    ``(A) In general.--The plan shall include a 
                description of the standards used to determine the 
                eligibility of caregivers for health care assistance 
                under the plan. Such standards may include (to the 
                extent consistent with this title) those relating to 
                the geographic areas to be served by the plan, age, 
                income and resources (including any standards relating 
                to spenddowns and disposition of resources), residency, 
                disability status (so long as any standard relating to 
                such status does not restrict eligibility), access to 
                or coverage under other health coverage, and duration 
                of eligibility. Such standards may not discriminate on 
                the basis of diagnosis.
                    ``(B) Limitations on eligibility standards.--Such 
                eligibility standards--
                            ``(i) shall, within any defined group of 
                        covered eligible caregivers, not cover such 
                        caregivers with a higher family income without 
                        covering caregivers with a lower family income, 
                        and
                            ``(ii) may not deny eligibility based on a 
                        caregiver having a preexisting medical 
                        condition.
            ``(2) Methodology.--The plan shall include a description of 
        methods of establishing and continuing eligibility and 
        enrollment.
            ``(3) Eligibility screening; coordination with other health 
        coverage programs.--The plan shall include a description of 
        procedures to be used to ensure--
                    ``(A) through both intake and followup screening, 
                that only eligible caregivers are furnished health care 
                assistance under the State plan;
                    ``(B) that eligible caregivers found through the 
                screening to be eligible for medical assistance under 
                the State medicaid plan under title XIX of the Social 
                Security Act are enrolled for such assistance under 
                such plan;
                    ``(C) that the insurance provided under the State 
                plan does not substitute for coverage under group 
                health plans;
                    ``(D) the provision of health care assistance to 
                eligible caregivers in the State who are Indians (as 
                defined in section 4(c) of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603(c))); and
                    ``(E) coordination with other public and private 
                programs providing creditable coverage for eligible 
                caregivers.
            ``(4) Nonentitlement.--Nothing in this title shall be 
        construed as providing an individual with an entitlement to 
        health care assistance under a State plan.
    ``(c) Outreach and Coordination.--A State plan shall include a 
description of the procedures to be used by the State to accomplish the 
following:
            ``(1) Outreach.--Outreach to caregivers likely to be 
        eligible for health care assistance under the plan or under 
        other public or private health coverage programs to inform such 
        care givers of the availability of, and to assist them in 
        enrolling in, such a program.
            ``(2) Coordination with other health insurance programs.--
        Coordination of the administration of the State program under 
        this title with other public and private health insurance 
        programs.
    ``(d) Payment or Premiums.--Nothing in this title shall be 
construed to prohibit a State from paying the eligible caregiver's 
share of premiums required for health care assistance provided to the 
caregiver under the State plan.

``SEC. 2803. COVERAGE REQUIREMENTS FOR HEALTH CARE ASSISTANCE.

    ``The health care assistance provided to an eligible caregiver 
under the plan in the form described in paragraph (1) of section 
2801(a) shall consist of any of the types of coverage, the benchmark 
benefit packages, the categories of services, existing programs, the 
cost sharing requirements, and the preexisting condition limitations 
described in section 2103 of the Social Security Act, and shall provide 
coverage for the dependent children of the eligible caregiver.

``SEC. 2804. ALLOTMENTS.

    ``(a) Appropriation.--For purpose of enabling States to provide 
assistance under this title, there is appropriated, out of any money in 
the Treasury not otherwise appropriated, the following:
            ``(1) For fiscal year 2002, $________________.
            ``(2) For fiscal year 2003, $________________.
            ``(3) For fiscal year 2004, $________________.
            ``(4) For fiscal year 2005, $________________.
            ``(5) For fiscal year 2006, $________________.
            ``(6) For fiscal year 2007, $________________.
            ``(7) For fiscal year 2008, $________________.
            ``(8) For fiscal year 2009, $________________.
    ``(b) Allotments to 50 States and District of Columbia.--
            ``(1) In general.--Of the amount available for allotment 
        under subsection (a) for a fiscal year, reduced by the amount 
        of allotments made under subsection (c) for such fiscal year, 
        the Secretary shall allot to each State an amount the bears 
        that same ratio to such available amount as the population of 
        the State in such fiscal year bears to the total populations of 
        all States in such fiscal year.
            ``(5) Adjustment for geographic variations in health 
        costs.--In making allotments under this subsection, the 
        Secretary shall adjust a State's allotment based on section 
        2104(b)(3) of the Social Security Act to reflect the geographic 
        variations in health costs.
    ``(c) Allotments to Territories.--
            ``(1) In general.--Of the amount available for allotment 
        under subsection (a) for a fiscal year, the Secretary shall 
        allot 0.25 percent among each of the commonwealths and 
        territories described in paragraph (3) in the same proportion 
        as the percentage specified in paragraph (2) for such 
        commonwealth or territory bears to the sum of such percentages 
        for all such commonwealths or territories so described.
            ``(2) Percentage.--The percentage specified in this 
        paragraph for--
                    ``(A) Puerto Rico is 91.6 percent,
                    ``(B) Guam is 3.5 percent,
                    ``(C) the Virgin Islands is 2.6 percent,
                    ``(D) American Samoa is 1.2 percent, and
                    ``(E) the Northern Mariana Islands is 1.1 percent.
            ``(3) Commonwealths and territories.--A commonwealth or 
        territory described in this paragraph is any of the following 
        if it has a State plan approved under this title:
                    ``(A) Puerto Rico.
                    ``(B) Guam.
                    ``(C) The Virgin Islands.
                    ``(D) American Samoa.
                    ``(E) The Northern Mariana Islands.
    ``(d) 3-Year Availability of Amounts Allotted.--Amounts allotted to 
a State pursuant to this section for a fiscal year shall remain 
available for expenditure by the State through the end of the second 
succeeding fiscal year; except that amounts reallotted to a State under 
subsection (e) shall be available for expenditure by the State through 
the end of the fiscal year in which they are reallotted.
    ``(e) Procedure for Redistribution of Unused Allotments.--The 
Secretary shall determine an appropriate procedure for redistribution 
of allotments from States that were provided allotments under this 
section for a fiscal year but that do not expend all of the amount of 
such allotments during the period in which such allotments are 
available for expenditure under subsection (d), to States that have 
fully expended the amount of their allotments under this section.

``SEC. 2805. PAYMENTS TO STATES.

    ``(a) In General.--Subject to the succeeding provisions of this 
section, the Secretary shall pay to each State with a plan approved 
under this title, from its allotment for a fiscal year under section 
2804, an amount for each quarter equal to the enhanced FMAP of 
expenditures in the quarter--
            ``(1) for health care assistance under the plan for 
        eligible caregivers in the form of providing health benefits 
        coverage that meets the requirements of section 2803; and
            ``(2) only to the extent permitted consistent with 
        subsection (c)--
                    ``(A) for payment for other health care assistance 
                for such caregivers;
                    ``(B) for expenditures for health services 
                initiatives under the plan for improving the health of 
                such caregivers;
                    ``(C) for expenditures for outreach activities as 
                provided in section 2802(c)(1) under the plan; and
                    ``(D) for other reasonable costs incurred by the 
                State to administer the plan.
    ``(b) Enhanced FMAP.--For purposes of subsection (a), the `enhanced 
FMAP', for a State for a fiscal year, is equal to the Federal medical 
assistance percentage (as defined in the first sentence of section 
1905(b) of the Social Security Act) for the State increased by a number 
of percentage points equal to 30 percent of the number of percentage 
points by which (1) such Federal medical assistance percentage for the 
State, is less than (2) 100 percent; but in no case shall the enhanced 
FMAP for a State exceed 85 percent.
    ``(c) Limitation on Certain Payments for Certain Expenditures.--
            ``(1) General limitations.--Funds provided to a State under 
        this title shall only be used to carry out the purposes of this 
        title (as described in section 2801).
            ``(2) Use of non-federal funds for state matching 
        requirement.--Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of non-Federal contributions required under subsection 
        (a).
            ``(3) Offset of receipts attributable to premiums and other 
        cost-sharing.--For purposes of subsection (a), the amount of 
        the expenditures under the plan shall be reduced by the amount 
        of any premiums and other cost-sharing received by the State.
            ``(4) Prevention of duplicative payments.--
                    ``(A) Other health plans.--No payment shall be made 
                to a State under this section for expenditures for 
                health care assistance provided for an eligible 
                caregiver under its plan to the extent that a private 
                insurer (as defined by the Secretary by regulation and 
                including a group health plan (as defined in section 
                607(1) of the Employee Retirement Income Security Act 
                of 1974), a service benefit plan, and a health 
                maintenance organization) would have been obligated to 
                provide such assistance but for a provision of its 
                insurance contract which has the effect of limiting or 
                excluding such obligation because the individual is 
                eligible for or is provided health care assistance 
                under the plan.
                    ``(B) Other federal governmental programs.--Except 
                as otherwise provided by law, no payment shall be made 
                to a State under this section for expenditures for 
                health care assistance provided for an eligible 
                caregiver under its plan to the extent that payment has 
                been made or can reasonably be expected to be made 
                promptly (as determined in accordance with regulations) 
                under any other federally operated or financed health 
                care insurance program, other than an insurance program 
                operated or financed by the Indian Health Service, as 
                identified by the Secretary. For purposes of this 
                paragraph, rules similar to the rules for overpayments 
                under section 1903(d)(2) of the Social Security Act 
                shall apply.
    ``(d) Maintenance of Effort.--
            ``(1) In medicaid eligibility standards.--No payment may be 
        made under subsection (a) with respect to health care 
        assistance provided under a State plan if the State adopts 
        income and resource standards and methodologies for purposes of 
        determining a caregiver's eligibility for medical assistance 
        under the State plan under title XIX of the Social Security Act 
        that are more restrictive than those applied as of June 1, 
        1997.
            ``(2) In amounts of payment expended for certain state-
        funded health insurance programs.--
                    ``(A) In general.--The amount of the allotment for 
                a State in a fiscal year (beginning with fiscal year 
                2002) shall be reduced by the amount by which--
                            ``(i) the total of the State health 
                        insurance expenditures for caregivers in the 
                        preceding fiscal year, is less than
                            ``(ii) the total of such expenditures in 
                        fiscal year 2000.
                    ``(B) State health insurance expenditures for 
                caregivers.--The term `State health insurance 
                expenditures for caregivers' means the following:
                            ``(i) The State share of expenditures under 
                        this title.
                            ``(ii) The State share of expenditures 
                        under title XIX of the Social Security Act that 
                        are attributable to an enhanced FMAP under 
                        section 1905(u) of such Act.
                            ``(iii) State expenditures under health 
                        benefits coverage under an existing 
                        comprehensive State-based program.
    ``(e) Advance Payment; Retrospective Adjustment.--The Secretary may 
make payments under this section for each quarter on the basis of 
advance estimates of expenditures submitted by the State and such other 
investigation as the Secretary may find necessary, and may reduce or 
increase the payments as necessary to adjust for any overpayment or 
underpayment for prior quarters.
    ``(f) Flexibility in Submittal of Claims.--Nothing in this section 
or subsections (d) and (e) of section 2804 shall be construed as 
preventing a State from claiming as expenditures in the quarter 
expenditures that were incurred in a previous quarter.

``SEC. 2806. PROCESS FOR SUBMISSION, APPROVAL, AND AMENDMENT OF STATE 
              PLANS.

    ``(a) Initial Plan.--
            ``(1) In general.--As a condition of receiving payment 
        under section 2805, a State shall submit to the Secretary a 
        State plan that meets the applicable requirements of this 
        title.
            ``(2) Approval.--Except as the Secretary may provide under 
        subsection (e), a State plan submitted under paragraph (1)--
                    ``(A) shall be approved for purposes of this title, 
                and
                    ``(B) shall be effective beginning with a calendar 
                quarter that is specified in the plan, but in no case 
                earlier than October 1, 2001.
    ``(b) Plan Amendments.--The provisions of section 2106(b) of the 
Social Security Act shall apply with respect to the amendment of a 
State plan under this title.
    ``(c) Disapproval of Plans and Plan Amendments.--
            ``(1) Prompt review of plan submittals.--The Secretary 
        shall promptly review State plans and plan amendments submitted 
        under this section to determine if they substantially comply 
        with the requirements of this title.
            ``(2) 90-day approval deadlines.--A State plan or plan 
        amendment is considered approved unless the Secretary notifies 
        the State in writing, within 90 days after receipt of the plan 
        or amendment, that the plan or amendment is disapproved (and 
        the reasons for disapproval) or that specified additional 
        information is needed.
            ``(3) Correction.--In the case of a disapproval of a plan 
        or plan amendment, the Secretary shall provide a State with a 
        reasonable opportunity for correction before taking financial 
        sanctions against the State on the basis of such disapproval.
    ``(d) Program Operation.--
            ``(1) In general.--The State shall conduct the program in 
        accordance with the plan (and any amendments) approved under 
        subsection (c) and with the requirements of this title.
            ``(2) Violations.--The Secretary shall establish a process 
        for enforcing requirements under this title. Such process shall 
        provide for the withholding of funds in the case of substantial 
        noncompliance with such requirements. In the case of an 
        enforcement action against a State under this paragraph, the 
        Secretary shall provide a State with a reasonable opportunity 
        for correction before taking financial sanctions against the 
        State on the basis of such an action.
    ``(e) Continued Approval.--An approved State caregivers health plan 
shall continue in effect unless and until the State amends the plan 
under subsection (b) or the Secretary finds, under subsection (d), 
substantial noncompliance of the plan with the requirements of this 
title.

``SEC. 2807. STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN 
              ADMINISTRATION.

    ``(a) Strategic Objectives and Performance Goals.--
            ``(1) Description.--A State plan shall include a 
        description of--
                    ``(A) the strategic objectives,
                    ``(B) the performance goals, and
                    ``(C) the performance measures,
        the State has established for providing health care assistance 
        to eligible caregivers under the plan and otherwise for 
        maximizing health benefits coverage for other caregivers 
        generally in the State.
            ``(2) Strategic objectives.--Such plan shall identify 
        specific strategic objectives relating to increasing the extent 
        of creditable health coverage among eligible caregivers.
            ``(3) Performance goals.--Such plan shall specify 1 or more 
        performance goals for each such strategic objective so 
        identified.
            ``(4) Performance measures.--Such plan shall describe how 
        performance under the plan will be--
                    ``(A) measured through objective, independently 
                verifiable means, and
                    ``(B) compared against performance goals, in order 
                to determine the State's performance under this title.
    ``(b) Records, Reports, Audits, and Evaluation.--
            ``(1) Data collection, records, and reports.--A State plan 
        shall include an assurance that the State will collect the 
        data, maintain the records, and furnish the reports to the 
        Secretary, at the times and in the standardized format the 
        Secretary may require in order to enable the Secretary to 
        monitor State program administration and compliance and to 
        evaluate and compare the effectiveness of State plans under 
        this title.
            ``(2) State assessment and study.--A State plan shall 
        include a description of the State's plan for the annual 
        assessments and reports under section 2808(a) and the 
        evaluation required by section 2808(b).
            ``(3) Audits.--A State plan shall include an assurance that 
        the State will afford the Secretary access to any records or 
        information relating to the plan for the purposes of review or 
        audit.
    ``(c) Program Development Process.--A State plan shall include a 
description of the process used to involve the public in the design and 
implementation of the plan and the method for ensuring ongoing public 
involvement.
    ``(d) Program Budget.--A State plan shall include a description of 
the budget for the plan. The description shall be updated periodically 
as necessary and shall include details on the planned use of funds and 
the sources of the non-Federal share of plan expenditures, including 
any requirements for cost-sharing by beneficiaries.
    ``(e) Application of Certain General Provisions.--The following 
sections of the Social Security Act shall apply to States under this 
title in the same manner as they apply to a State under title XIX or 
title XI of such Act, as appropriate:
            ``(1) Title xix provisions.--
                    ``(A) Section 1902(a)(4)(C) (relating to conflict 
                of interest standards).
                    ``(B) Paragraphs (2), (16), and (17) of section 
                1903(i) (relating to limitations on payment).
                    ``(C) Section 1903(w) (relating to limitations on 
                provider taxes and donations).
            ``(2) Title xi provisions.--
                    ``(A) Section 1115 (relating to waiver authority).
                    ``(B) Section 1116 (relating to administrative and 
                judicial review), but only insofar as consistent with 
                this title.
                    ``(C) Section 1124 (relating to disclosure of 
                ownership and related information).
                    ``(D) Section 1126 (relating to disclosure of 
                information about certain convicted individuals).
                    ``(E) Section 1128A (relating to civil monetary 
                penalties).
                    ``(F) Section 1128B(d) (relating to criminal 
                penalties for certain additional charges).
                    ``(G) Section 1132 (relating to periods within 
                which claims must be filed).

``SEC. 2808. ANNUAL REPORTS; EVALUATIONS.

    ``(a) Annual Report.--The State shall--
            ``(1) assess the operation of the State plan under this 
        title in each fiscal year, including the progress made in 
        reducing the number of uncovered eligible caregivers; and
            ``(2) report to the Secretary, by January 1 following the 
        end of the fiscal year, on the result of the assessment.
    ``(b) State Evaluations.--
            ``(1) In general.--By March 31, 2003, each State that has a 
        State plan shall submit to the Secretary an evaluation that 
        includes each of the following:
                    ``(A) An assessment of the effectiveness of the 
                State plan in increasing the number of caregivers with 
                creditable health coverage.
                    ``(B) A description and analysis of the 
                effectiveness of elements of the State plan, 
                including--
                            ``(i) the characteristics of the caregivers 
                        assisted under the State plan including family 
                        income, and the assisted caregiver's access to 
                        or coverage by other health insurance prior to 
                        the State plan and after eligibility for the 
                        State plan ends,
                            ``(ii) the quality of health coverage 
                        provided including the types of benefits 
                        provided,
                            ``(iii) the amount and level (including 
                        payment of part or all of any premium) of 
                        assistance provided by the State,
                            ``(iv) the service area of the State plan,
                            ``(v) the time limits for coverage of a 
                        caregiver under the State plan,
                            ``(vi) the State's choice of health 
                        benefits coverage and other methods used for 
                        providing health care assistance, and
                            ``(vii) the sources of non-Federal funding 
                        used in the State plan.
                    ``(C) An assessment of the effectiveness of other 
                public and private programs in the State in increasing 
                the availability of affordable quality individual and 
                family health insurance for caregivers.
                    ``(D) A review and assessment of State activities 
                to coordinate the plan under this title with other 
                public and private programs providing health care and 
                health care financing, including medicaid and maternal 
                and child health services.
                    ``(E) An analysis of changes and trends in the 
                State that affect the provision of accessible, 
                affordable, quality health insurance and health care to 
                caregivers.
                    ``(F) A description of any plans the State has for 
                improving the availability of health insurance and 
                health care for caregivers.
                    ``(G) Recommendations for improving the program 
                under this title.
                    ``(H) Any other matters the State and the Secretary 
                consider appropriate.
            ``(2) Report of the secretary.--The Secretary shall submit 
        to Congress and make available to the public by December 31, 
        2003, a report based on the evaluations submitted by States 
        under paragraph (1), containing any conclusions and 
        recommendations the Secretary considers appropriate.

``SEC. 2809. MISCELLANEOUS PROVISIONS.

    ``(a) HIPAA.--Health benefits coverage provided under section 
2801(a)(1) shall be treated as creditable coverage for purposes of part 
7 of subtitle B of title I of the Employee Retirement Income Security 
Act of 1974, title XXVII of the Public Health Service Act, and subtitle 
K of the Internal Revenue Code of 1986.
    ``(b) ERISA.--Nothing in this title shall be construed as affecting 
or modifying section 514 of the Employee Retirement Income Security Act 
of 1974 with respect to a group health plan (as defined in section 
2791(a)(1) of this Act.
    ``(c) Limitation on Entities.--Notwithstanding any other provision 
of this title, a State may limit the application of this title to 
eligible caregivers who are employed by entities that provide services 
to a specific percentage of individuals who receive assistance under, 
or through, Federal or State assistance programs.

``SEC. 2810. DEFINITIONS.

    (a) Health Care Assistance.--For purposes of this title, the term 
`health care assistance' means payment for part or all of the cost of 
health benefits coverage for eligible caregivers (and the dependent 
children of such caregivers) that includes any of the following (and 
includes, in the case described in section 2805(a)(2)(A), payment for 
part or all of the cost of providing any of the following), as 
specified under the State plan:
            ``(1) Inpatient hospital services.
            ``(2) Outpatient hospital services.
            ``(3) Physician services.
            ``(4) Surgical services.
            ``(5) Clinic services (including health center services) 
        and other ambulatory health care services.
            ``(6) Prescription drugs and biologicals and the 
        administration of such drugs and biologicals, only if such 
        drugs and biologicals are not furnished for the purpose of 
        causing, or assisting in causing, the death, suicide, 
        euthanasia, or mercy killing of a person.
            ``(7) Over-the-counter medications.
            ``(8) Laboratory and radiological services.
            ``(9) Prenatal care and prepregnancy family planning 
        services and supplies.
            ``(10) Inpatient mental health services, other than 
        services described in paragraph (18) but including services 
        furnished in a State-operated mental hospital and including 
        residential or other 24-hour therapeutically planned structured 
        services.
            ``(11) Outpatient mental health services, other than 
        services described in paragraph (19) but including services 
        furnished in a State-operated mental hospital and including 
        community-based services.
            ``(12) Durable medical equipment and other medically-
        related or remedial devices (such as prosthetic devices, 
        implants, eyeglasses, hearing aids, dental devices, and 
        adaptive devices).
            ``(13) Disposable medical supplies.
            ``(14) Home and community-based health care services and 
        related supportive services (such as home health nursing 
        services, home health aide services, personal care, assistance 
        with activities of daily living, chore services, day care 
        services, respite care services, training for family members, 
        and minor modifications to the home).
            ``(15) Nursing care services (such as nurse practitioner 
        services, nurse midwife services, advanced practice nurse 
        services, private duty nursing care, pediatric nurse services, 
        and respiratory care services) in a home, school, or other 
        setting.
            ``(16) Dental services.
            ``(17) Inpatient substance abuse treatment services and 
        residential substance abuse treatment services.
            ``(18) Outpatient substance abuse treatment services.
            ``(19) Case management services.
            ``(20) Care coordination services.
            ``(21) Physical therapy, occupational therapy, and services 
        for individuals with speech, hearing, and language disorders.
            ``(22) Hospice care.
            ``(23) Any other medical, diagnostic, screening, 
        preventive, restorative, remedial, therapeutic, or 
        rehabilitative services (whether in a facility, home, school, 
        or other setting) if recognized by State law and only if the 
        service is--
                    ``(A) prescribed by or furnished by a physician or 
                other licensed or registered practitioner within the 
                scope of practice as defined by State law,
                    ``(B) performed under the general supervision or at 
                the direction of a physician, or
                    ``(C) furnished by a health care facility that is 
                operated by a State or local government or is licensed 
                under State law and operating within the scope of the 
                license.
            ``(24) Premiums for private health care insurance coverage.
            ``(25) Medical transportation.
            ``(26) Enabling services (such as transportation, 
        translation, and outreach services) only if designed to 
        increase the accessibility of primary and preventive health 
care services for eligible low-income individuals.
            ``(27) Any other health care services or items specified by 
        the Secretary and not excluded under this section.
    ``(b) Eligible Caregiver Defined.--For purposes of this title, the 
term `eligible caregiver' means an individual--
            ``(1) who has been determined eligible by the State under 
        this title for assistance under the State plan;
            ``(2) who--
                    ``(A) subject to section 2809(c)--
                            ``(i) is employed as a child care provider, 
                        an adult day care provider, a personal 
                        attendant for disabled individuals, a nursing 
                        home aide, a home health aide, or in any other 
                        caregiving position determined appropriate by 
                        the State, with an entity that is licensed or 
                        certified under State law, or is otherwise 
                        providing services under a State license or 
                        certification; and
                            ``(ii) is certified by, or enrolled in, an 
                        accredited program recognized by the State as 
                        having received training necessary in order to 
                        be employed in a position described in 
                        subparagraph (A); or
                    ``(B)(i) is providing caregiver services on a full-
                time basis for a relative; and
                    ``(ii) does not otherwise have access to employer-
                sponsored health insurance coverage;
            ``(3) who is not found to be eligible for medical 
        assistance under title XIX of the Social Security Act or 
        covered under a group health plan or under health insurance 
        coverage (as such terms are defined in section 2791 of this 
        Act); and
            ``(4) who meets any other criteria determined appropriate 
        by the State.
    ``(c) Additional Definitions.--For purposes of this title:
            ``(1) Creditable health coverage.--The term `creditable 
        health coverage' has the meaning given the term `creditable 
        coverage' under section 2701(c) of this Act and includes 
        coverage that meets the requirements of section 2803 provided 
        to an eligible caregiver under this title.
            ``(2) Group health plan; health insurance coverage; etc.--
        The terms `group health plan', `group health insurance 
        coverage', and `health insurance coverage' have the meanings 
        given such terms in section 2791 of this Act.
            ``(3) Poverty line defined.--The term `poverty line' has 
        the meaning given such term in section 673(2) of the Community 
        Services Block Grant Act (42 U.S.C. 9902(2)), including any 
        revision required by such section.
            ``(4) Preexisting condition exclusion.--The term 
        `preexisting condition exclusion' has the meaning given such 
        term in section 2701(b)(1)(A) of this Act.
            ``(5) State plan; plan.--Unless the context otherwise 
        requires, the terms `State plan' and `plan' mean a State plan 
        approved under section 2806.''.
                                 <all>