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






                                                       Calendar No. 582
107th CONGRESS
  2d Session
                                 S. 321

                          [Report No. 107-265]

 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, Mr. 
Wellstone, Mr. Hollings, Ms. Stabenow, Mr. Miller, Mr. Hutchinson, Ms. 
Cantwell, Mr. Enzi, Mr. Hagel, Mrs. Carnahan, Mr. Bond, Mr. Hatch, Mr. 
   Cochran, Mr. Specter, Mr. Burns, Mrs. Hutchison, Mr. Bunning, Mr. 
 Ensign, Mr. Carper, and Mr. Murkowski) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

                           September 9, 2002

               Reported by Mr. Baucus, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; 
              TABLE OF CONTENTS.</DELETED>

<DELETED>    (a) Short Title.--This Act may be cited as the ``Family 
Opportunity Act of 2001'' or the ``Dylan Lee James Act''.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (c) Table of Contents.--The table of contents of this Act 
is as follows:</DELETED>

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

<DELETED>SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO 
              PURCHASE MEDICAID COVERAGE FOR SUCH CHILDREN.</DELETED>

<DELETED>    (a) State Option To Allow Families of Disabled Children To 
Purchase Medicaid Coverage for Such Children.--</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (A) in subsection (a)(10)(A)(ii)--
                </DELETED>
                        <DELETED>    (i) by striking ``or'' at the end 
                        of subclause (XVII);</DELETED>
                        <DELETED>    (ii) by adding ``or'' at the end 
                        of subclause (XVIII); and</DELETED>
                        <DELETED>    (iii) by adding at the end the 
                        following new subclause:</DELETED>
                                <DELETED>    ``(XIX) who are disabled 
                                children described in subsection 
                                (cc)(1);''; and</DELETED>
                <DELETED>    (B) by adding at the end the following new 
                subsection:</DELETED>
<DELETED>    ``(cc)(1) Individuals described in this paragraph are 
individuals--</DELETED>
        <DELETED>    ``(A) who have not attained 18 years of 
        age;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(C) whose family income does not exceed such 
        income level as the State establishes and does not exceed--
        </DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.''.</DELETED>
        <DELETED>    (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:</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(ii) if such coverage is obtained--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(II) treat such coverage as a third 
                party liability under subsection (a)(25).</DELETED>
<DELETED>    ``(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.''.</DELETED>
<DELETED>    (b) State Option To Impose Income-Related Premiums.--
Section 1916 (42 U.S.C. 1396o) is amended--</DELETED>
        <DELETED>    (1) in subsection (a), by striking ``subsection 
        (g)'' and inserting ``subsections (g) and (h)''; and</DELETED>
        <DELETED>    (2) by adding at the end the following new 
        subsection:</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(2) A premium requirement imposed under paragraph (1) 
may only apply to the extent that--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(B) the requirement is imposed consistent with 
        section 1902(cc)(2)(A)(ii)(I).</DELETED>
<DELETED>    ``(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.''.</DELETED>
<DELETED>    (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),''.</DELETED>
<DELETED>    (d) Technical Amendments.--</DELETED>
        <DELETED>    (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).</DELETED>
        <DELETED>    (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)''.</DELETED>
        <DELETED>    (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)''.</DELETED>
<DELETED>    (e) Effective Date.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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).</DELETED>

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

<DELETED>    (a) In General.--Section 1915(c) (42 U.S.C. 1396n(c)) is 
amended--</DELETED>
        <DELETED>    (1) in paragraph (1)--</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (B) in the second sentence, by inserting 
                ``, or inpatient psychiatric hospital services for 
                individuals under age 21'' before the period;</DELETED>
        <DELETED>    (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'';</DELETED>
        <DELETED>    (3) by striking paragraph (2)(C) and inserting the 
        following:</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    (4) in paragraph (7)(A)--</DELETED>
                <DELETED>    (A) by inserting ``, or inpatient 
                psychiatric hospital services for individuals under age 
                21,'' after ``intermediate care facility for the 
                mentally retarded''; and</DELETED>
                <DELETED>    (B) by inserting ``, or who would require 
                inpatient psychiatric hospital services for individuals 
                under age 21'' before the period.</DELETED>
<DELETED>    (b) Effective Date.--The amendments made by subsection (a) 
apply with respect to medical assistance provided on or after January 
1, 2001.</DELETED>

<DELETED>SEC. 4. DEMONSTRATION OF COVERAGE UNDER THE MEDICAID PROGRAM 
              OF CHILDREN WITH POTENTIALLY SEVERE 
              DISABILITIES.</DELETED>

<DELETED>    (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.).</DELETED>
<DELETED>    (b) Child With a Potentially Severe Disability Defined.--
</DELETED>
        <DELETED>    (1) In general.--In this section, the term ``child 
        with a potentially severe disability'' means, with respect to a 
        demonstration project, an individual who--</DELETED>
                <DELETED>    (A) has not attained 21 years of 
                age;</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (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).</DELETED>
        <DELETED>    (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).</DELETED>
<DELETED>    (c) Approval of Demonstration Projects.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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:</DELETED>
                <DELETED>    (A) Independent evaluation.--The State 
                provides for an independent evaluation of the project 
                to be conducted during fiscal year 2006.</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (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:</DELETED>
                        <DELETED>    (i) Enrollment and financial 
                        statistics on--</DELETED>
                                <DELETED>    (I) the total number of 
                                children with a potentially severe 
                                disability enrolled in the 
                                demonstration project, disaggregated by 
                                disability;</DELETED>
                                <DELETED>    (II) the services provided 
                                by category or code and the cost of 
                                each service so categorized or coded; 
                                and</DELETED>
                                <DELETED>    (III) the number of 
                                children enrolled in the demonstration 
                                project who also receive services 
                                through private insurance.</DELETED>
                        <DELETED>    (ii) With respect to the report 
                        submitted for fiscal year 2006, the results of 
                        the independent evaluation conducted under 
                        subparagraph (A).</DELETED>
                        <DELETED>    (iii) Such additional information 
                        as the Secretary may require.</DELETED>
        <DELETED>    (3) Limitations on federal funding.--</DELETED>
                <DELETED>    (A) Appropriation.--</DELETED>
                        <DELETED>    (i) In general.--Out of any funds 
                        in the Treasury not otherwise appropriated, 
                        there is appropriated to carry out this 
                        section--</DELETED>
                                <DELETED>    (I) $16,666,000 for each 
                                of fiscal years 2002 and 2003; 
                                and</DELETED>
                                <DELETED>    (II) $16,667,000 for each 
                                of fiscal years 2004 through 
                                2007.</DELETED>
                        <DELETED>    (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).</DELETED>
                <DELETED>    (B) Limitation on payments.--In no case 
                may--</DELETED>
                        <DELETED>    (i) the aggregate amount of 
                        payments made by the Secretary to States under 
                        this section exceed $100,000,000;</DELETED>
                        <DELETED>    (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</DELETED>
                        <DELETED>    (iii) payments be provided by the 
                        Secretary for a fiscal year after fiscal year 
                        2010.</DELETED>
                <DELETED>    (C) Funds allocated to states.--</DELETED>
                        <DELETED>    (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.</DELETED>
                        <DELETED>    (ii) Availability.--Funds 
                        allocated to a State under a grant made under 
                        this section for a fiscal year shall remain 
                        available until expended.</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (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.).</DELETED>

<DELETED>SEC. 5. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH 
              INFORMATION CENTERS.</DELETED>

<DELETED>    Section 501 (42 U.S.C. 701) is amended by adding at the 
end the following new subsection:</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(2) The family-to-family health information centers 
described in this paragraph are centers that--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(B) provide information regarding the health 
        care needs of, and resources available for, children with 
        disabilities or special health care needs;</DELETED>
        <DELETED>    ``(C) identify successful health delivery models 
        for such children;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(E) provide training and guidance regarding 
        caring for such children;</DELETED>
        <DELETED>    ``(F) conduct outreach activities to the families 
        of such children, health professionals, schools, and other 
        appropriate entities and individuals; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).''.</DELETED>

<DELETED>SEC. 6. RESTORATION OF MEDICAID ELIGIBILITY FOR CERTAIN SSI 
              BENEFICIARIES.</DELETED>

<DELETED>    (a) In General.--Section 1902(a)(10)(A)(i)(II) (42 U.S.C. 
1396a(a)(10)(A)(i)(II)) is amended--</DELETED>
        <DELETED>    (1) by inserting ``(aa)'' after 
        ``(II)'';</DELETED>
        <DELETED>    (2) by striking ``or who are'' and inserting ``, 
        (bb) who are''; and</DELETED>
        <DELETED>    (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'''.</DELETED>
<DELETED>    (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.</DELETED>

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 2002'' 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. Development and support of family-to-family health information 
                            centers.
Sec. 5. 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) 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) 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) 250 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--
                            ``(I) any medical assistance provided to an 
                        individual whose family income exceeds 250 
                        percent of such poverty line may only be 
                        provided with State funds; and
                            ``(II) no Federal financial participation 
                        shall be provided under section 1903(a) for any 
                        medical assistance provided to such an 
                        individual.''.
            (2) Interaction with employer-sponsored family coverage.--
        Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by paragraph 
        (1)(B), 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 
shall--
            ``(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 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, a 
State, subject to paragraph (1)(C)(ii), 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 Amendments.--Section 1903(f)(4) (42 U.S.C. 
1396b(f)(4)) is amended in the matter preceding subparagraph (A), by 
inserting ``1902(a)(10)(A)(ii)(XIX),'' after 
``1902(a)(10)(A)(ii)(XVIII),''.
    (d) Effective Date.--The amendments made by this section shall 
apply to medical assistance for items and services furnished on or 
after October 1, 2004.

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 
                would require 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 
                would require 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) in paragraph (2)(C)--
                    (A) by inserting ``, or who are determined to be 
                likely to require inpatient psychiatric hospital 
                services for individuals under age 21,'' after ``, or 
                intermediate care facility for the mentally retarded''; 
                and
                    (B) by striking ``or services in an intermediate 
                care facility for the mentally retarded'' and inserting 
                ``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 would require 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, 
2003.

SEC. 4. 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)(A) 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)--
            ``(i) there is appropriated to the Secretary, out of any 
        money in the Treasury not otherwise appropriated--
                    ``(I) $3,000,000 for fiscal year 2003;
                    ``(II) $4,000,000 for fiscal year 2004; and
                    ``(III) $5,000,000 for fiscal year 2005; and
            ``(ii) there is authorized to be appropriated to the 
        Secretary, $5,000,000 for each of fiscal years 2006 and 2007.
    ``(B) Funds appropriated or authorized to be appropriated under 
subparagraph (A) shall--
            ``(i) be 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); and
            ``(ii) 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 Secretary shall develop family-to-family health 
information centers described in paragraph (2) under this subsection in 
accordance with the following:
            ``(A) With respect to fiscal year 2003, such centers shall 
        be developed in not less than 25 States.
            ``(B) With respect to fiscal year 2004, such centers shall 
        be developed in not less than 40 States.
            ``(C) With respect to fiscal year 2005, such centers shall 
        be developed in not less than 50 States and the District of 
        Columbia.
    ``(4) 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)(A).
    ``(5) For purposes of this subsection, the term `State' means each 
of the 50 States and the District of Columbia.''.

SEC. 5. 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 ``) and'' and inserting ``and'';
            (3) by striking ``section or who are'' and inserting 
        ``section), (bb) who are''; and
            (4) 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.




                                                       Calendar No. 582

107th CONGRESS

  2d Session

                                 S. 321

                          [Report No. 107-265]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                           September 9, 2002

                       Reported with an amendment