[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 724 Reported in Senate (RS)]






                                                       Calendar No. 541
107th CONGRESS
  2d Session
                                 S. 724

                          [Report No. 107-233]

 To amend title XXI of the Social Security Act to provide for coverage 
of pregnancy-related assistance for targeted low-income pregnant women.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 6, 2001

  Mr. Bond (for himself, Mr. Breaux, Ms. Landrieu, Mrs. Lincoln, Ms. 
 Collins, Mr. Lieberman, Mr. Cochran, Mr. Lott, Mr. DeWine, Mr. Dodd, 
Mr. Daschle, and Mr. Johnson) introduced the following bill; which was 
          read twice and referred to the Committee on Finance

                             August 1, 2002

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

_______________________________________________________________________

                                 A BILL


 
 To amend title XXI of the Social Security Act to provide for coverage 
of pregnancy-related assistance for targeted low-income pregnant women.

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

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Mothers and Newborns Health 
Insurance Act of 2001''.</DELETED>

<DELETED>SEC. 2. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT 
              WOMEN UNDER A STATE CHILD HEALTH PLAN.</DELETED>

<DELETED>    (a) In General.--Title XXI of the Social Security Act (42 
U.S.C. 1397aa et seq.) is amended by adding at the end the 
following:</DELETED>

<DELETED>``SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED 
              PREGNANT WOMEN.</DELETED>

<DELETED>    ``(a) Optional Coverage.--Notwithstanding any other 
provision of this title, a State child health plan may provide for 
coverage of pregnancy-related assistance for targeted low-income 
pregnant women in accordance with this section.</DELETED>
<DELETED>    ``(b) Definitions.--For purposes of this 
section:</DELETED>
        <DELETED>    ``(1) Pregnancy-related assistance.--The term 
        `pregnancy-related assistance' has the meaning given the term 
        `child health assistance' in section 2110(a) as if any 
        reference to targeted low-income children were a reference to 
        targeted low-income pregnant women, except that the assistance 
        shall be limited to services related to pregnancy (which 
        include prenatal, delivery, and postpartum services) and to 
        other conditions that may complicate pregnancy and shall not 
        include pre-pregnancy services and supplies.</DELETED>
        <DELETED>    ``(2) Targeted low-income pregnant woman.--The 
        term `targeted low-income pregnant woman' has the meaning given 
        the term `targeted low-income child' in section 2110(b) as if 
        any reference to a child were deemed a reference to a woman 
        during pregnancy and through the end of the month in which the 
        60-day period (beginning on the last day of her pregnancy) 
        ends.</DELETED>
<DELETED>    ``(c) References to Terms and Special Rules.--In the case 
of, and with respect to, a State providing for coverage of pregnancy-
related assistance to targeted low-income pregnant women under 
subsection (a), the following special rules apply:</DELETED>
        <DELETED>    ``(1) Any reference in this title (other than 
        subsection (b)) to a targeted low-income child is deemed to 
        include a reference to a targeted low-income pregnant 
        woman.</DELETED>
        <DELETED>    ``(2) Any such reference to child health 
        assistance with respect to such women is deemed a reference to 
        pregnancy-related assistance.</DELETED>
        <DELETED>    ``(3) Any such reference to a child is deemed a 
        reference to a woman during pregnancy and the period described 
        in subsection (b)(2).</DELETED>
        <DELETED>    ``(4) The reference in section 2107(e)(1)(D) to 
        section 1920A (relating to presumptive eligibility for 
        children) is deemed a reference to section 1920 (relating to 
        presumptive eligibility for pregnant women).</DELETED>
        <DELETED>    ``(5) The medicaid applicable income level is 
        deemed a reference to the income level established under 
        section 1902(l)(2)(A).</DELETED>
        <DELETED>    ``(6) Subsection (a) of section 2103 (relating to 
        required scope of health insurance coverage) shall not apply 
        insofar as a State limits coverage to services described in 
        subsection (b)(1) and the reference to such section in section 
        2105(a)(1) is deemed not to require, in such case, compliance 
        with the requirements of section 2103(a).</DELETED>
        <DELETED>    ``(7) There shall be no exclusion of benefits for 
        services described in subsection (b)(1) based on any pre-
        existing condition, and no waiting period (including a waiting 
        period to carry out section 2102(b)(3)(C)) shall 
        apply.</DELETED>
<DELETED>    ``(d) No Impact on Allotments.--Nothing in this section 
shall be construed as affecting the amount of any initial allotment 
provided to a State under section 2104(b).</DELETED>
<DELETED>    ``(e) Application of Funding Restrictions.--The coverage 
under this section (and the funding of such coverage) is subject to the 
restrictions of section 2105(c).''.</DELETED>
<DELETED>    (b) Application of Qualified Entities to Presumptive 
Eligibility for Pregnant Women Under Medicaid.--Section 1920(b) of the 
Social Security Act (42 U.S.C. 1396r-1(b)) is amended by adding at the 
end after and below paragraph (2) the following flush 
sentence:</DELETED>
<DELETED>``The term `qualified provider' includes a qualified entity as 
defined in section 1920A(b)(3).''.</DELETED>
<DELETED>    (c) Conforming Amendments.--Section 2102(b)(1)(B) of the 
Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--</DELETED>
        <DELETED>    (1) by striking ``and'' at the end of clause 
        (i);</DELETED>
        <DELETED>    (2) by striking the period at the end of clause 
        (ii) and inserting ``, and''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
                        <DELETED>    ``(iii) may not apply a waiting 
                        period (including a waiting period to carry out 
                        paragraph (3)(C)) in the case of a targeted 
                        low-income child who is pregnant, if the State 
                        provides for coverage of pregnancy-related 
                        assistance for targeted low-income pregnant 
                        women in accordance with section 
                        2111.''.</DELETED>
<DELETED>    (d) Effective Date.--The amendments made by this section 
take effect on the date of enactment of this Act and apply to 
allotments under title XXI of the Social Security Act (42 U.S.C. 1397aa 
et seq.) for all fiscal years.</DELETED>

<DELETED>SEC. 3. AUTOMATIC ENROLLMENT FOR CHILDREN BORN TO WOMEN 
              RECEIVING PREGNANCY-RELATED ASSISTANCE.</DELETED>

<DELETED>    (a) In General.--Section 2111 of the Social Security Act, 
as added by section 2, is amended by adding at the end the 
following:</DELETED>
<DELETED>    ``(f) Automatic Enrollment for Children Born to Women 
Receiving Pregnancy-Related Assistance.--Notwithstanding any other 
provision of this title or title XIX, if a child is born to a targeted 
low-income pregnant woman who was receiving pregnancy-related 
assistance under this section on the date of the child's birth, the 
child shall be deemed to have applied for child health assistance under 
the State child health plan on the date of such birth, to have been 
found eligible for such assistance under such plan (or, in the case of 
a State that provides such assistance through the provision of medical 
assistance under a plan under title XIX to have applied for medical 
assistance under such title and to have been found eligible for such 
assistance under such title on the date of such birth) and to remain 
eligible for such assistance until the child attains 1 year of age, so 
long as the child is a member of the woman's household.''.</DELETED>
<DELETED>    (b) Effective Date.--The amendment made by subsection (a) 
takes effect on the date of enactment of this Act and applies to 
allotments under title XXI of the Social Security Act (42 U.S.C. 1397aa 
et seq.) for all fiscal years.</DELETED>

<DELETED>SEC. 4. EXPANDED AVAILABILITY OF FUNDING FOR ADMINISTRATIVE 
              COSTS RELATED TO OUTREACH AND ELIGIBILITY 
              DETERMINATIONS.</DELETED>

<DELETED>    Section 1931(h) of the Social Security Act (42 U.S.C. 
1396u-1(h)) is amended--</DELETED>
        <DELETED>    (1) by striking the subsection heading and 
        inserting ``Increased Federal Matching Rate for Administrative 
        Costs Related to Outreach and Eligibility 
        Determinations'';</DELETED>
        <DELETED>    (2) in paragraph (2), by striking ``eligibility 
        determinations'' and all that follows and inserting 
        ``determinations of the eligibility of children and pregnant 
        women for benefits under the State plan under this title or 
        title XXI, outreach to children and pregnant women likely to be 
        eligible for such benefits, and such other outreach- and 
        eligibility-related activities as the Secretary may approve.''; 
        and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(4) Encouraging use of local and community-based 
        organizations in outreach and enrollment activities.--The 
        Secretary shall establish a procedure under which, if a State 
        does not otherwise obligate the amounts made available under 
        this subsection, local and community-based public or nonprofit 
        private organizations (including local and county governments, 
        public health departments, community health centers, children's 
        hospitals, and disproportionate share hospitals) may seek to 
        have administrative costs relating to outreach and enrollment 
        of children and pregnant women under this title and title XXI 
        treated as administrative costs of a State described in section 
        1903(a)(7), if such organizations have the permission of the 
        State involved. A State may require such an organization to 
        provide payment of such amounts as the State would otherwise be 
        responsible for in order to obtain payment under this 
        paragraph.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Mothers and Newborns Health 
Insurance Act of 2002''.

SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN PREGNANT 
              WOMEN UNDER MEDICAID AND SCHIP.

    (a) Medicaid.--
            (1) Authority to expand coverage.--Section 1902(l)(2)(A)(i) 
        of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)(i)) is 
        amended by inserting ``(or such higher percent as the State may 
        elect for purposes of expenditures for medical assistance for 
        pregnant women described in section 1905(u)(4)(A))'' after 
        ``185 percent''.
            (2) Enhanced matching funds available if certain conditions 
        met.--Section 1905 of the Social Security Act (42 U.S.C. 1396d) 
        is amended--
                    (A) in the fourth sentence of subsection (b), by 
                striking ``or subsection (u)(3)'' and inserting ``, 
                (u)(3), or (u)(4)''; and
                    (B) in subsection (u)--
                            (i) by redesignating paragraph (4) as 
                        paragraph (5); and
                            (ii) by inserting after paragraph (3) the 
                        following:
    ``(4) For purposes of the fourth sentence of subsection (b) and 
section 2105(a), the expenditures described in this paragraph are the 
following:
            ``(A) Certain pregnant women.--If the conditions described 
        in subparagraph (B) are met, expenditures for medical 
        assistance for pregnant women described in subsection (n) or 
        under section 1902(l)(1)(A) in a family the income of which 
        exceeds 185 percent of the poverty line, but does not exceed 
        the income eligibility level established under title XXI for a 
        targeted low-income child.
            ``(B) Conditions.--The conditions described in this 
        subparagraph are the following:
                    ``(i) The State plans under this title and title 
                XXI do not provide coverage for pregnant women 
                described in subparagraph (A) with higher family income 
                without covering such pregnant women with a lower 
                family income.
                    ``(ii) The State does not apply an effective income 
                level for pregnant women that is lower than the 
                effective income level (expressed as a percent of the 
                poverty line and considering applicable income 
                disregards) that has been specified under the State 
                plan under subsection (a)(10)(A)(i)(III) or (l)(2)(A) 
                of section 1902, as of January 1, 2002, to be eligible 
                for medical assistance as a pregnant woman.
            ``(C) Definition of poverty line.--In this subsection, the 
        term `poverty line' has the meaning given such term in section 
        2110(c)(5).''.
            (3) Payment from title xxi allotment for medicaid expansion 
        costs; elimination of counting medicaid child presumptive 
        eligibility costs against title xxi allotment.--Section 
        2105(a)(1) of the Social Security Act (42 U.S.C. 1397ee(a)(1)) 
        is amended--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``(or, in the case of expenditures described 
                in subparagraph (B), the Federal medical assistance 
                percentage (as defined in the first sentence of section 
                1905(b)))''; and
                    (B) by striking subparagraph (B) and inserting the 
                following:
                    ``(B) for the provision of medical assistance that 
                is attributable to expenditures described in section 
                1905(u)(4)(A);''.
    (b) SCHIP.--
            (1) Coverage.--Title XXI of the Social Security Act (42 
        U.S.C. 1397aa et seq.) is amended by adding at the end the 
        following:

``SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN.

    ``(a) Optional Coverage.--Notwithstanding any other provision of 
this title, a State may provide for coverage, through an amendment to 
its State child health plan under section 2102, of pregnancy-related 
assistance for targeted low-income pregnant women in accordance with 
this section, but only if--
            ``(1) the State has established an income eligibility level 
        for pregnant women under subsection (a)(10)(A)(i)(III) or 
        (l)(2)(A) of section 1902 that is at least 185 percent of the 
        income official poverty line; and
            ``(2) the State meets the conditions described in section 
        1905(u)(4)(B).
    ``(b) Definitions.--For purposes of this title:
            ``(1) Pregnancy-related assistance.--The term `pregnancy-
        related assistance' has the meaning given the term child health 
        assistance in section 2110(a) as if any reference to targeted 
        low-income children were a reference to targeted low-income 
        pregnant women, except that the assistance shall be limited to 
        services related to pregnancy (which include prenatal, 
        delivery, and postpartum services and services described in 
        section 1905(a)(4)(C)) and to other conditions that may 
        complicate pregnancy.
            ``(2) Targeted low-income pregnant woman.--The term 
        `targeted low-income pregnant woman' means a woman--
                    ``(A) during pregnancy and through the end of the 
                month in which the 60-day period (beginning on the last 
                day of her pregnancy) ends;
                    ``(B) whose family income exceeds the effective 
                income level (expressed as a percent of the poverty 
                line and considering applicable income disregards) that 
                has been specified under subsection (a)(10)(A)(i)(III) 
                or (l)(2)(A) of section 1902, as of January 1, 2002, to 
                be eligible for medical assistance as a pregnant woman 
                under title XIX but does not exceed the income 
                eligibility level established under the State child 
                health plan under this title for a targeted low-income 
                child; and
                    ``(C) who satisfies the requirements of paragraphs 
                (1)(A), (1)(C), (2), and (3) of section 2110(b).
    ``(c) References to Terms and Special Rules.--In the case of, and 
with respect to, a State providing for coverage of pregnancy-related 
assistance to targeted low-income pregnant women under subsection (a), 
the following special rules apply:
            ``(1) Any reference in this title (other than in subsection 
        (b)) to a targeted low-income child is deemed to include a 
        reference to a targeted low-income pregnant woman.
            ``(2) Any such reference to child health assistance with 
        respect to such women is deemed a reference to pregnancy-
        related assistance.
            ``(3) Any such reference to a child is deemed a reference 
        to a woman during pregnancy and the period described in 
        subsection (b)(2)(A).
            ``(4) In applying section 2102(b)(3)(B), any reference to 
        children found through screening to be eligible for medical 
        assistance under the State medicaid plan under title XIX is 
        deemed a reference to pregnant women.
            ``(5) There shall be no exclusion of benefits for services 
        described in subsection (b)(1) based on any preexisting 
        condition and no waiting period (including any waiting period 
        imposed to carry out section 2102(b)(3)(C)) shall apply.
            ``(6) Subsection (a) of section 2103 (relating to required 
        scope of health insurance coverage) shall not apply insofar as 
        a State limits coverage to services described in subsection 
        (b)(1) and the reference to such section in section 
        2105(a)(1)(C) is deemed not to require, in such case, 
        compliance with the requirements of section 2103(a).
            ``(7) In applying section 2103(e)(3)(B) in the case of a 
        pregnant woman provided coverage under this section, the 
        limitation on total annual aggregate cost-sharing shall be 
        applied to such pregnant woman.
            ``(8) The reference in section 2107(e)(1)(D) to section 
        1920A (relating to presumptive eligibility for children) is 
        deemed a reference to section 1920 (relating to presumptive 
        eligibility for pregnant women).
    ``(d) Automatic Enrollment for Children Born to Women Receiving 
Pregnancy-Related Assistance.--If a child is born to a targeted low-
income pregnant woman who was receiving pregnancy-related assistance 
under this section on the date of the child's birth, the child shall be 
deemed to have applied for child health assistance under the State 
child health plan and to have been found eligible for such assistance 
under such plan or to have applied for medical assistance under title 
XIX and to have been found eligible for such assistance under such 
title, as appropriate, on the date of such birth and to remain eligible 
for such assistance until the child attains 1 year of age. During the 
period in which a child is deemed under the preceding sentence to be 
eligible for child health or medical assistance, the child health or 
medical assistance eligibility identification number of the mother 
shall also serve as the identification number of the child, and all 
claims shall be submitted and paid under such number (unless the State 
issues a separate identification number for the child before such 
period expires).''.
            (2) Additional allotments for providing coverage of 
        pregnant women.--
                    (A) In general.--Section 2104 of the Social 
                Security Act (42 U.S.C. 1397dd) is amended by inserting 
                after subsection (c) the following:
    ``(d) Additional Allotments for Providing Coverage of Pregnant 
Women.--
            ``(1) Appropriation; total allotment.--For the purpose of 
        providing additional allotments to States under this title, 
        there is appropriated, out of any money in the Treasury not 
        otherwise appropriated, for each of fiscal years 2003 through 
        2006, $200,000,000.
            ``(2) State and territorial allotments.--In addition to the 
        allotments provided under subsections (b) and (c), subject to 
        paragraphs (3) and (4), of the amount available for the 
        additional allotments under paragraph (1) for a fiscal year, 
        the Secretary shall allot to each State with a State child 
health plan approved under this title--
                    ``(A) in the case of such a State other than a 
                commonwealth or territory described in subparagraph 
                (B), the same proportion as the proportion of the 
                State's allotment under subsection (b) (determined 
                without regard to subsection (f)) to the total amount 
                of the allotments under subsection (b) for such States 
                eligible for an allotment under this paragraph for such 
                fiscal year; and
                    ``(B) in the case of a commonwealth or territory 
                described in subsection (c)(3), the same proportion as 
                the proportion of the commonwealth's or territory's 
                allotment under subsection (c) (determined without 
                regard to subsection (f)) to the total amount of the 
                allotments under subsection (c) for commonwealths and 
                territories eligible for an allotment under this 
                paragraph for such fiscal year.
            ``(3) Use of additional allotment.--Additional allotments 
        provided under this subsection are not available for amounts 
        expended before October 1, 2002. Such amounts are available for 
        amounts expended on or after such date for child health 
        assistance for targeted low-income children, as well as for 
        pregnancy-related assistance for targeted low-income pregnant 
        women.
            ``(4) No payments unless election to expand coverage of 
        pregnant women.--No payments may be made to a State under this 
        title from an allotment provided under this subsection unless 
        the State provides pregnancy-related assistance for targeted 
        low-income pregnant women under this title, or provides medical 
        assistance for pregnant women under title XIX, whose family 
        income exceeds the effective income level applicable under 
        subsection (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 to a 
        family of the size involved as of January 1, 2002.''.
                    (B) Conforming amendments.--Section 2104 of the 
                Social Security Act (42 U.S.C. 1397dd) is amended--
                            (i) in subsection (a), in the matter 
                        preceding paragraph (1), by inserting ``subject 
                        to subsection (d),'' after ``under this 
                        section,'';
                            (ii) in subsection (b)(1), by inserting 
                        ``and subsection (d)'' after ``Subject to 
                        paragraph (4)''; and
                            (iii) in subsection (c)(1), by inserting 
                        ``subject to subsection (d),'' after ``for a 
                        fiscal year,''.
            (3) Additional conforming amendments.--
                    (A) No cost-sharing for pregnancy-related 
                benefits.--Section 2103(e)(2) of the Social Security 
                Act (42 U.S.C. 1397cc(e)(2)) is amended--
                            (i) in the heading, by inserting ``or 
                        pregnancy-related services'' after ``preventive 
                        services''; and
                            (ii) by inserting before the period at the 
                        end the following: ``or for pregnancy-related 
                        services''.
                    (B) No waiting period.--Section 2102(b)(1)(B) of 
                the Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is 
                amended--
                            (i) by striking ``, and'' at the end of 
                        clause (i) and inserting a semicolon;
                            (ii) by striking the period at the end of 
                        clause (ii) and inserting ``; and''; and
                            (iii) by adding at the end the following:
                            ``(iii) may not apply a waiting period 
                        (including a waiting period to carry out 
                        paragraph (3)(C)) in the case of a targeted 
                        low-income pregnant woman.''.
    (c) Other Amendments to Medicaid.--
            (1) Eligibility of a newborn.--Section 1902(e)(4) of the 
        Social Security Act (42 U.S.C. 1396a(e)(4)) is amended in the 
        first sentence by striking ``so long as the child is a member 
        of the woman's household and the woman remains (or would remain 
        if pregnant) eligible for such assistance''.
            (2) Application of qualified entities to presumptive 
        eligibility for pregnant women under medicaid.--Section 1920(b) 
        of the Social Security Act (42 U.S.C. 1396r-1(b)) is amended by 
        adding at the end after and below paragraph (2) the following 
        flush sentence:
``The term `qualified provider' includes a qualified entity as defined 
in section 1920A(b)(3).''.
    (d) Effective Date.--The amendments made by this section apply to 
items and services furnished on or after October 1, 2002, without 
regard to whether regulations implementing such amendments have been 
promulgated.

SEC. 3. REVIEW OF STATE AGENCY BLINDNESS AND DISABILITY DETERMINATIONS.

    Section 1633 of the Social Security Act (42 U.S.C. 1383b) is 
amended by adding at the end the following:
    ``(e)(1) The Commissioner of Social Security shall review 
determinations, made by State agencies pursuant to subsection (a) in 
connection with applications for benefits under this title on the basis 
of blindness or disability, that individuals who have attained 18 years 
of age are blind or disabled as of a specified onset date. The 
Commissioner of Social Security shall review such a determination 
before any action is taken to implement the determination.
    ``(2)(A) In carrying out paragraph (1), the Commissioner of Social 
Security shall review--
            ``(i) at least 25 percent of all determinations referred to 
        in paragraph (1) that are made in fiscal year 2003; and
            ``(ii) at least 50 percent of all such determinations that 
        are made in fiscal year 2004 or thereafter.
    ``(B) In carrying out subparagraph (A), the Commissioner of Social 
Security shall, to the extent feasible, select for review the 
determinations which the Commissioner of Social Security identifies as 
being the most likely to be incorrect.''.
            Amend the title so as to read: ``A bill to amend titles XIX 
        and XXI of the Social Security Act to expand or add coverage of 
        pregnant women under the medicaid and State children's health 
        insurance program, and for other purposes.''.




                                                       Calendar No. 541

107th CONGRESS

  2d Session

                                 S. 724

                          [Report No. 107-233]

_______________________________________________________________________

                                 A BILL

 To amend title XXI of the Social Security Act to provide for coverage 
of pregnancy-related assistance for targeted low-income pregnant women.

_______________________________________________________________________

                             August 1, 2002

        Reported with an amendment and an amendment to the title