[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 321 Introduced in Senate (IS)]







107th CONGRESS
  1st Session
                                 S. 321

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 13, 2001

 Mr. Grassley (for himself, Mr. Kennedy, Mr. Jeffords, Mr. Baucus, Ms. 
   Snowe, Mr. Rockefeller, Mr. Daschle, Mr. Breaux, Mr. Conrad, Mr. 
  Graham, Mr. Bingaman, Mr. Kerry, Mr. Torricelli, Mrs. Lincoln, Mr. 
 Akaka, Mr. Bayh, Mr. Biden, Mrs. Boxer, Mr. Byrd, Mr. L. Chafee, Mr. 
Cleland, Mrs. Clinton, Ms. Collins, Mr. Corzine, Mr. Crapo, Mr. Dayton, 
    Mr. DeWine, Mr. Dodd, Mr. Domenici, Mr. Dorgan, Mr. Durbin, Mr. 
Edwards, Mrs. Feinstein, Mr. Frist, Mr. Harkin, Mr. Helms, Mr. Inouye, 
    Mr. Johnson, Mr. Kohl, Ms. Landrieu, Mr. Leahy, Mr. Levin, Mr. 
Lieberman, Mr. Lugar, Ms. Mikulski, Mrs. Murray, Mr. Nelson of Florida, 
   Mr. Reed, Mr. Reid, Mr. Roberts, Mr. Santorum, Mr. Sarbanes, Mr. 
Schumer, Mr. Smith of Oregon, Mr. Thomas, Mr. Thurmond, Mr. Warner, and 
Mr. Wellstone) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; TABLE OF 
              CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Family Opportunity 
Act of 2001'' or the ``Dylan Lee James Act''.
    (b) Amendments to Social Security Act.--Except as otherwise 
specifically provided, whenever in this Act an amendment 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 that 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; amendments to Social Security Act; table of 
                            contents.
Sec. 2. Opportunity for families of disabled children to purchase 
                            medicaid coverage for such children.
Sec. 3. Treatment of inpatient psychiatric hospital services for 
                            individuals under age 21 in home or 
                            community-based services waivers.
Sec. 4. Demonstration of coverage under the medicaid program of 
                            children with potentially severe 
                            disabilities.
Sec. 5. Development and support of family-to-family health information 
                            centers.
Sec. 6. Restoration of medicaid eligibility for certain SSI 
                            beneficiaries.

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

    (a) State Option To Allow Families of Disabled Children To Purchase 
Medicaid Coverage for Such Children.--
            (1) In general.--Section 1902 (42 U.S.C. 1396a), 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), is 
        amended--
                    (A) in subsection (a)(10)(A)(ii)--
                            (i) by striking ``or'' at the end of 
                        subclause (XVII);
                            (ii) by adding ``or'' at the end of 
                        subclause (XVIII); and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(XIX) who are disabled children 
                                described in subsection (cc)(1);''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(cc)(1) Individuals described in this paragraph are individuals--
            ``(A) who have not attained 18 years of age;
            ``(B) who would be considered disabled under section 
        1614(a)(3)(C) (determined without regard to the reference to 
        age in that section) but for having earnings or deemed income 
        or resources (as determined under title XVI for children) that 
        exceed the requirements for receipt of supplemental security 
        income benefits; and
            ``(C) whose family income does not exceed such income level 
        as the State establishes and does not exceed--
                    ``(i) 300 percent of the income official poverty 
                line (as defined by the Office of Management and 
                Budget, and revised annually in accordance with section 
                673(2) of the Omnibus Budget Reconciliation Act of 
                1981) applicable to a family of the size involved; or
                    ``(ii) such higher percent of such poverty line as 
                a State may establish, except that no Federal financial 
                participation shall be provided under section 1903(a) 
                for any medical assistance provided to an individual 
                who would not be described in this subsection but for 
                this clause.''.
            (2) Interaction with employer-sponsored family coverage.--
        Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by paragraph 
        (1), is amended by adding at the end the following new 
        paragraph:
    ``(2)(A) If an employer of a parent of an individual described in 
paragraph (1) offers family coverage under a group health plan (as 
defined in section 2791(a) of the Public Health Service Act), the State 
may--
            ``(i) require such parent to apply for, enroll in, and pay 
        premiums for, such coverage as a condition of such parent's 
        child being or remaining eligible for medical assistance under 
        subsection (a)(10)(A)(ii)(XIX) if the parent is determined 
        eligible for such coverage and the employer contributes at 
        least 50 percent of the total cost of annual premiums for such 
        coverage; and
            ``(ii) if such coverage is obtained--
                    ``(I) subject to paragraph (2) of section 1916(h), 
                reduce the premium imposed by the State under that 
                section (if any) in an amount that reasonably reflects 
                the premium contribution made by the parent for private 
                coverage on behalf of a child with a disability; and
                    ``(II) treat such coverage as a third party 
                liability under subsection (a)(25).
    ``(B) In the case of a parent to which subparagraph (A) applies, if 
the family income of such parent does not exceed 300 percent of the 
income official poverty line (referred to in paragraph (1)(C)(i)), a 
State may provide for payment of any portion of the annual premium for 
such family coverage that the parent is required to pay. Any payments 
made by the State under this subparagraph shall be considered, for 
purposes of section 1903(a), to be payments for medical assistance.''.
    (b) State Option To Impose Income-Related Premiums.--Section 1916 
(42 U.S.C. 1396o) is amended--
            (1) in subsection (a), by striking ``subsection (g)'' and 
        inserting ``subsections (g) and (h)''; and
            (2) by adding at the end the following new subsection:
    ``(h)(1) With respect to disabled children provided medical 
assistance under section 1902(a)(10)(A)(ii)(XIX), subject to paragraph 
(2), a State may (in a uniform manner for such children) require the 
families of such children to pay monthly premiums set on a sliding 
scale based on family income.
    ``(2) A premium requirement imposed under paragraph (1) may only 
apply to the extent that--
            ``(A) the aggregate amount of such premium and any premium 
        that the parent is required to pay for family coverage under 
        section 1902(cc)(2)(A)(i) does not exceed 5 percent of the 
        family's income; and
            ``(B) the requirement is imposed consistent with section 
        1902(cc)(2)(A)(ii)(I).
    ``(3) A State shall not require prepayment of a premium imposed 
pursuant to paragraph (1) and shall not terminate eligibility of a 
child under section 1902(a)(10)(A)(ii)(XIX) for medical assistance 
under this title on the basis of failure to pay any such premium until 
such failure continues for a period of not less than 60 days from the 
date on which the premium became past due. The State may waive payment 
of any such premium in any case where the State determines that 
requiring such payment would create an undue hardship.''.
    (c) Conforming Amendment.--Section 1903(f)(4) (42 U.S.C. 
1396b(f)(4)), as amended by section 710(a) 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 in the 
matter preceding subparagraph (A) by inserting 
``1902(a)(10)(A)(ii)(XIX),'' after ``1902(a)(10)(A) (ii)(XVIII),''.
    (d) Technical Amendments.--
            (1) Section 1902 (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).
            (2) Section 1902(a)(15) (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)''.
            (3) Section 1915(b) (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)''.
    (e) Effective Date.--
            (1) In general.--The amendments made by subsections (a), 
        (b), and (c) shall apply to medical assistance for items and 
        services furnished on or after January 1, 2002.
            (2) Technical amendments.--The amendments made by 
        subsection (d) shall take effect as if included in the 
        enactment of section 702 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).

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

    (a) In General.--Section 1915(c) (42 U.S.C. 1396n(c)) is amended--
            (1) in paragraph (1)--
                    (A) in the first sentence, by inserting ``, or 
                inpatient psychiatric hospital services for individuals 
                under age 21,'' after ``intermediate care facility for 
                the mentally retarded''; and
                    (B) in the second sentence, by inserting ``, or 
                inpatient psychiatric hospital services for individuals 
                under age 21'' before the period;
            (2) in paragraph (2)(B), by striking ``or services in an 
        intermediate care facility for the mentally retarded'' each 
        place it appears and inserting ``, services in an intermediate 
        care facility for the mentally retarded, or inpatient 
        psychiatric hospital services for individuals under age 21'';
            (3) by striking paragraph (2)(C) and inserting the 
        following:
            ``(C) such individuals who are determined to be likely to 
        require the level of care provided in a hospital, nursing 
        facility, or intermediate care facility for the mentally 
        retarded, or inpatient psychiatric hospital services for 
individuals under age 21, are informed of the feasible alternatives, if 
available under the waiver, at the choice of such individuals, to the 
provision of inpatient hospital services, nursing facility services, 
services in an intermediate care facility for the mentally retarded, or 
inpatient psychiatric hospital services for individuals under age 
21;''; and
            (4) in paragraph (7)(A)--
                    (A) by inserting ``, or inpatient psychiatric 
                hospital services for individuals under age 21,'' after 
                ``intermediate care facility for the mentally 
                retarded''; and
                    (B) by inserting ``, or who would require inpatient 
                psychiatric hospital services for individuals under age 
                21'' before the period.
    (b) Effective Date.--The amendments made by subsection (a) apply 
with respect to medical assistance provided on or after January 1, 
2001.

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

    (a) State Application.--A State may apply to the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') for approval of a demonstration project (in this section 
referred to as a ``demonstration project'') under which up to a 
specified maximum number of children with a potentially severe 
disability (as defined in subsection (b)) are provided medical 
assistance under the State medicaid plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.).
    (b) Child With a Potentially Severe Disability Defined.--
            (1) In general.--In this section, the term ``child with a 
        potentially severe disability'' means, with respect to a 
        demonstration project, an individual who--
                    (A) has not attained 21 years of age;
                    (B) has a physical or mental condition, disease, 
                disorder (including a congenital birth defect or a 
                metabolic condition), injury, or developmental 
                disability that was incurred before the individual 
                attained such age; and
                    (C) is reasonably expected, but for the receipt of 
                medical assistance under the State medicaid plan, to 
                reach the level of disability defined under section 
                1614(a)(3) of the Social Security Act (42 U.S.C. 
                1382c(a)(3)), (determined without regard to the 
                reference to age in subparagraph (C) of that section).
            (2) Exception.--Such term does not include an individual 
        who would be considered disabled under section 1614(a)(3)(C) of 
        the Social Security Act (42 U.S.C. 1382c(a)(3)(C)) (determined 
        without regard to the reference to age in that section).
    (c) Approval of Demonstration Projects.--
            (1) In general.--Subject to paragraph (3), the Secretary 
        shall approve applications under subsection (a) that meet the 
        requirements of paragraph (2) and such additional terms and 
        conditions as the Secretary may require. The Secretary may 
        waive the requirement of section 1902(a)(1) of the Social 
        Security Act (42 U.S.C. 1396a(a)(1)) to allow for sub-State 
        demonstrations.
            (2) Terms and conditions of demonstration projects.--The 
        Secretary may not approve a demonstration project under this 
        section unless the State provides assurances satisfactory to 
        the Secretary that the following conditions are or will be met:
                    (A) Independent evaluation.--The State provides for 
                an independent evaluation of the project to be 
                conducted during fiscal year 2006.
                    (B) Consultation for development of criteria.--The 
                State consults with appropriate pediatric health 
                professionals in establishing the criteria for 
                determining whether a child has a potentially severe 
                disability.
                    (C) Annual report.--The State submits an annual 
                report to the Secretary (in a uniform form and manner 
                established by the Secretary) on the use of funds 
                provided under the grant that includes the following:
                            (i) Enrollment and financial statistics 
                        on--
                                    (I) the total number of children 
                                with a potentially severe disability 
                                enrolled in the demonstration project, 
                                disaggregated by disability;
                                    (II) the services provided by 
                                category or code and the cost of each 
                                service so categorized or coded; and
                                    (III) the number of children 
                                enrolled in the demonstration project 
                                who also receive services through 
                                private insurance.
                            (ii) With respect to the report submitted 
                        for fiscal year 2006, the results of the 
                        independent evaluation conducted under 
                        subparagraph (A).
                            (iii) Such additional information as the 
                        Secretary may require.
            (3) Limitations on federal funding.--
                    (A) Appropriation.--
                            (i) In general.--Out of any funds in the 
                        Treasury not otherwise appropriated, there is 
                        appropriated to carry out this section--
                                    (I) $16,666,000 for each of fiscal 
                                years 2002 and 2003; and
                                    (II) $16,667,000 for each of fiscal 
                                years 2004 through 2007.
                            (ii) Budget authority.--Clause (i) 
                        constitutes budget authority in advance of 
                        appropriations Acts and represents the 
                        obligation of the Federal Government to provide 
                        for the payment of the amounts appropriated 
                        under clause (i).
                    (B) Limitation on payments.--In no case may--
                            (i) the aggregate amount of payments made 
                        by the Secretary to States under this section 
                        exceed $100,000,000;
                            (ii) the aggregate amount of payments made 
                        by the Secretary to States for administrative 
                        expenses relating to the evaluations and annual 
                        reports required under subparagraphs (A) and 
                        (C) of paragraph (2) exceed $2,000,000 of such 
                        $100,000,000; or
                            (iii) payments be provided by the Secretary 
                        for a fiscal year after fiscal year 2010.
                    (C) Funds allocated to states.--
                            (i) In general.--The Secretary shall 
                        allocate funds to States based on their 
                        applications and the availability of funds. In 
                        making such allocations, the Secretary shall 
                        ensure an equitable distribution of funds among 
                        States with large populations and States with 
                        small populations.
                            (ii) Availability.--Funds allocated to a 
                        State under a grant made under this section for 
                        a fiscal year shall remain available until 
                        expended.
                    (D) Funds not allocated to states.--Funds not 
                allocated to States in the fiscal year for which they 
                are appropriated shall remain available in succeeding 
                fiscal years for allocation by the Secretary using the 
                allocation formula established under this section.
                    (E) Payments to states.--The Secretary shall pay to 
                each State with a demonstration project approved under 
                this section, from its allocation under subparagraph 
                (C), an amount for each quarter equal to the Federal 
                medical assistance percentage (as defined in section 
                1905(b) of the Social Security Act (42 U.S.C. 
                1395d(b))) of expenditures in the quarter for medical 
                assistance provided to children with a potentially 
                severe disability.
    (d) Recommendation.--Not later than October 1, 2005, the Secretary 
shall submit a recommendation to the Committee on Commerce of the House 
of Representatives and the Committee on Finance of the Senate regarding 
whether the demonstration project established under this section should 
be continued after fiscal year 2007.
    (e) State Defined.--In this section, the term ``State'' has the 
meaning given such term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.).

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

    Section 501 (42 U.S.C. 701) is amended by adding at the end the 
following new subsection:
    ``(c)(1) In addition to amounts appropriated under subsection (a) 
and retained under section 502(a)(1) for the purpose of carrying out 
activities described in subsection (a)(2), there is appropriated to the 
Secretary, out of any money in the Treasury not otherwise appropriated, 
for the purpose of enabling the Secretary (through grants, contracts, 
or otherwise) to provide for special projects of regional and national 
significance for the development and support of family-to-family health 
information centers described in paragraph (2), $10,000,000 for each of 
fiscal years 2002 through 2007. Funds appropriated under this paragraph 
shall remain available until expended.
    ``(2) The family-to-family health information centers described in 
this paragraph are centers that--
            ``(A) assist families of children with disabilities or 
        special health care needs to make informed choices about health 
        care in order to promote good treatment decisions, cost-
        effectiveness, and improved health outcomes for such children;
            ``(B) provide information regarding the health care needs 
        of, and resources available for, children with disabilities or 
        special health care needs;
            ``(C) identify successful health delivery models for such 
        children;
            ``(D) develop with representatives of health care 
        providers, managed care organizations, health care purchasers, 
        and appropriate State agencies a model for collaboration 
        between families of such children and health professionals;
            ``(E) provide training and guidance regarding caring for 
        such children;
            ``(F) conduct outreach activities to the families of such 
        children, health professionals, schools, and other appropriate 
        entities and individuals; and
            ``(G) are staffed by families of children with disabilities 
        or special health care needs who have expertise in Federal and 
        State public and private health care systems and health 
        professionals.
    ``(3) The provisions of this title that are applicable to the funds 
made available to the Secretary under section 502(a)(1) apply in the 
same manner to funds made available to the Secretary under paragraph 
(1).''.

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

    (a) In General.--Section 1902(a)(10)(A)(i)(II) (42 U.S.C. 
1396a(a)(10)(A)(i)(II)) is amended--
            (1) by inserting ``(aa)'' after ``(II)'';
            (2) by striking ``or who are'' and inserting ``, (bb) who 
        are''; and
            (3) by inserting before the comma at the end the following: 
        ``, or (cc) who are under 21 years of age and with respect to 
        whom supplemental security income benefits would be paid under 
        title XVI if subparagraphs (A) and (B) of section 1611(c)(7) 
        were applied without regard to the phrase `the first day of the 
        month following'''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to medical assistance for items and services furnished on or 
after the first day of the first calendar quarter that begins after the 
date of enactment of this Act.
                                 <all>