[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1238 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1238

   To amend titles XVIII, XIX, and XXI of the Social Security Act to 
            improve women's health, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 11, 2003

Mrs. Lincoln (for herself, Mrs. Murray, Ms. Landrieu, and Ms. Cantwell) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend titles XVIII, XIX, and XXI of the Social Security Act to 
            improve women's health, 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 ``Improving Women's 
Health Act of 2003''.
    (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.
      TITLE I--IMPROVING PREVENTIVE HEALTH BENEFITS UNDER MEDICARE

Sec. 101. Therapy and counseling for cessation of tobacco use.
Sec. 102. Counseling for post-menopausal women.
Sec. 103. Screening for diminished visual acuity.
Sec. 104. Screening for hearing impairment.
Sec. 105. Expansion of eligibility for bone mass measurement.
Sec. 106. coverage of cardiovascular screening tests.
Sec. 107. Coverage of medical nutrition therapy services for 
                            beneficiaries with cardiovascular diseases.
Sec. 108. Medicare coverage of diabetes laboratory diagnostic tests.
Sec. 109. Coverage of annual screening pap smear and pelvic exams.
Sec. 110. Adjustments to local fee schedules for clinical laboratory 
                            tests for improvement in cervical cancer 
                            detection.
Sec. 111. Enhanced reimbursement under the medicare program for 
                            screening and diagnostic mammography 
                            services; not counting certain radiology 
                            residents against graduate medical 
                            education limitations.
Sec. 112. Elimination of deductibles and coinsurance for existing 
                            preventive health benefits.
 TITLE II--IMPROVING MEDICARE FOR FAMILY CAREGIVERS BY COVERING ADULT 
                              DAY SERVICES

Sec. 201. Findings.
Sec. 202. Medicare coverage of substitute adult day services.
 TITLE III--IMPROVING AND EXPANDING PRENATAL CARE FOR LOW-INCOME WOMEN

Sec. 301. State option to expand or add coverage of certain pregnant 
                            women under medicaid and schip.
Sec. 302. Optional coverage of legal immigrants under the medicaid 
                            program and SCHIP.
Sec. 303. Promoting cessation of tobacco use under the medicaid 
                            program.
Sec. 304. Promoting cessation of tobacco use under the maternal and 
                            child health services block grant program.
Sec. 305. State option to provide family planning services and supplies 
                            to individuals with incomes that do not 
                            exceed a State's income eligibility level 
                            for medical assistance.
Sec. 306. State option to extend the postpartum period for provision of 
                            family planning services and supplies.

      TITLE I--IMPROVING PREVENTIVE HEALTH BENEFITS UNDER MEDICARE

SEC. 101. THERAPY AND COUNSELING FOR CESSATION OF TOBACCO USE.

    (a) Coverage.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is 
amended--
            (1) in subparagraph (U), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (V)(iii), by adding ``and'' after the 
        semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(W) supplemental preventive health services (as defined 
        in subsection (ww));''.
    (b) Services Described.--Section 1861 (42 U.S.C. 1395x) is amended 
by adding at the end the following new subsection:

               ``Supplemental Preventive Health Services

    ``(ww) The term `supplemental preventive health services' means the 
following:
            ``(1)(A) Therapy and counseling for cessation of tobacco 
        use for individuals who use tobacco products or who are being 
        treated for tobacco use that is furnished--
                    ``(i) by or under the supervision of a physician; 
                or
                    ``(ii) by any other health care professional who--
                            ``(I) is legally authorized to furnish such 
                        services under State law (or the State 
                        regulatory mechanism provided by State law) of 
                        the State in which the services are furnished; 
                        and
                            ``(II) is authorized to receive payment for 
                        other services under this title or is 
                        designated by the Secretary for this purpose.
            ``(B) Subject to subparagraph (C), such term is limited 
        to--
                    ``(i) therapy and counseling services recommended 
                in `Treating Tobacco Use and Dependence: A Clinical 
                Practice Guideline', published by the Public Health 
                Service in June 2000, or any subsequent modification of 
                such Guideline; and
                    ``(ii) such other therapy and counseling services 
                that the Secretary recognizes to be effective.
            ``(C) Such term shall not include coverage for drugs or 
        biologicals that are not otherwise covered under this title.''.
    (c) Payment and Elimination of Cost-Sharing for All Supplemental 
Preventive Health Services.--
            (1) Payment and elimination of coinsurance.--Section 
        1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) in subparagraph (N), by inserting ``other than 
                supplemental preventive health services (as defined in 
                section 1861(ww))'' after ``(as defined in section 
                1848(j)(3))'';
                    (B) by striking ``and'' before ``(U)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (V) with respect to supplemental 
                preventive health services (as defined in section 
                1861(ww)), the amount paid shall be 100 percent of the 
                lesser of the actual charge for the services or the 
                amount determined under the payment basis determined 
                under section 1848 by the Secretary for the particular 
                supplemental preventive health service involved''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting 
        ``(2)(W),'' after ``(2)(S),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--The third sentence of section 1866(a)(2)(A) (42 
        U.S.C. 1395cc(a)(2)(A)) is amended by inserting after 
        ``1861(s)(10)(A)'' the following: ``, with respect to 
        supplemental preventive health services (as defined in section 
        1861(ww)),''.
            (4) Elimination of deductible.--The first sentence of 
        section 1833(b) (42 U.S.C. 1395l(b)) is amended--
                    (A) by striking ``and'' before ``(6)''; and
                    (B) by inserting before the period the following: 
                ``, and (7) such deductible shall not apply with 
                respect to supplemental preventive health services (as 
                defined in section 1861(ww))''.
    (d) Application of Limits on Billing.--Section 1842(b)(18)(C) (42 
U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following 
new clause:
            ``(vii) Any health care professional designated under 
        section 1861(ww)(1)(A)(ii)(II) to perform therapy and 
        counseling for cessation of tobacco use.''.
    (e) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2004.

SEC. 102. COUNSELING FOR POST-MENOPAUSAL WOMEN.

    (a) Coverage.--Section 1861(ww) (42 U.S.C. 1395x(s)(2)), as amended 
by section 101(b), is amended by adding at the end the following new 
paragraph:
            ``(2)(A) Counseling for post-menopausal women (as defined 
        in subparagraph (B)).
            ``(B)(i) For purposes of subparagraph (A), the term 
        `counseling for post-menopausal women' means counseling 
        provided to a post-menopausal woman regarding--
                    ``(I) the symptoms, risk factors, and conditions 
                associated with menopause;
                    ``(II) appropriate treatment options for post-
                menopausal women, including hormone replacement 
                therapy; and
                    ``(III) other interventions that can be implemented 
                to prevent or delay the onset of health risks 
                associated with menopause.
            ``(ii) Such term does not include coverage for drugs or 
        biologicals that are not otherwise covered under this title.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to services furnished on or after January 1, 2004.

SEC. 103. SCREENING FOR DIMINISHED VISUAL ACUITY.

    (a) Coverage.--Section 1861(ww) (42 U.S.C. 1395x(s)(2)), as amended 
by section 102(a), is amended by adding at the end the following new 
paragraph:
            ``(3)(A) Screening for diminished visual acuity (as defined 
        in subparagraph (B)).
            ``(B) For purposes of subparagraph (A), the term `screening 
        for diminished visual acuity' means a screening for diminished 
        visual acuity that is furnished by or under the supervision of 
        an optometrist or ophthalmologist who is legally authorized to 
        furnish such services under State law (or the State regulatory 
        mechanism provided by State law) of the State in which the 
        services are furnished.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to services furnished on or after January 1, 2004.

SEC. 104. SCREENING FOR HEARING IMPAIRMENT.

    (a) Coverage.--Section 1861(ww) (42 U.S.C. 1395x(s)(2)), as amended 
by section 103(a), is amended by adding at the end the following new 
paragraph:
            ``(4)(A) Screening for hearing impairment (as defined in 
        subparagraph (B)).
            ``(B) For purposes of subparagraph (A), the term `screening 
        for hearing impairment' means the following services:
                    ``(i) A screening for hearing impairment using 
                periodic questions that is furnished by--
                            ``(I) a physician, including an 
                        otolaryngologist;
                            ``(II) a qualified audiologist (as defined 
                        in subsection (ll)(3)(B)); or
                            ``(III) any other health care professional 
                        who is legally authorized to furnish such 
                        screening under State law (or the State 
                        regulatory mechanism provided by State law) of 
                        the State in which the screening is furnished.
                    ``(ii) If the answers to such questions indicate 
                potential hearing impairment, an otoscopic examination 
                and an audiometric screening test that are furnished by 
                an otolaryngologist or a qualified audiologist (as so 
                defined).
                    ``(iii) If the results of such examination or test 
                indicate a need for assistive listening devices 
                (whether or not such examination or test was based on a 
                screening or was diagnostic), counseling about such 
                devices that is furnished by an otolaryngologist or a 
                qualified audiologist (as so defined).''.
    (b) Effective Date.--The amendment made by this section shall apply 
to services furnished on or after January 1, 2004.

SEC. 105. EXPANSION OF ELIGIBILITY FOR BONE MASS MEASUREMENT.

    (a) Expansion.--Paragraph (2) of section 1861(rr) (42 U.S.C. 
1395x(rr)(2)) is amended to read as follows:
    ``(2) For purposes of this subsection, the term `qualified 
individual' means an individual who is (in accordance with regulations 
prescribed by the Secretary)--
            ``(A) an estrogen-deficient woman (including those 
        receiving hormone replacement therapy);
            ``(B) an individual with low trauma or fragility fractures 
        (including vertebral abnormalities and hip, rib, wrist, pelvic, 
        or proximal humeral fractures);
            ``(C) an individual receiving long-term medications that 
        have associations to bone loss or osteoporosis (including 
glucocorticoid therapy and androgen deprivation therapy);
            ``(D) an individual with a long-term medical condition that 
        has association to osteoporosis (including primary 
        hyperparathyroidism);
            ``(E) a man with risk factors for osteoporosis such as 
        hypogonadism; and
            ``(F) an individual being monitored to assess the response 
        to, or efficacy of, an approved osteoporosis therapy.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to services furnished on or after January 1, 2004.

SEC. 106. COVERAGE OF CARDIOVASCULAR SCREENING TESTS.

    (a) Services Described.--Section 1861(ww) (42 U.S.C. 1395x), as 
amended by section 105(a), is amended by adding at the end the 
following new paragraph:
            ``(5)(A) Cardiovascular screening tests for the early 
        detection of cardiovascular disease, including the following 
        diagnostic tests:
                    ``(i) Tests for the determination of cholesterol 
                levels.
                    ``(ii) Tests for the determination of lipid levels 
                of the blood.
                    ``(iii) Screening for hypertension.
                    ``(iv) Such other tests for cardiovascular disease 
                as the Secretary may approve.
            ``(B)(i) Subject to clause (ii), the Secretary shall 
        establish standards, in consultation with appropriate 
        organizations, regarding the frequency and type of 
        cardiovascular screening tests.
            ``(ii) With respect to the frequency of cardiovascular 
        screening tests approved by the Secretary under clause (i), in 
        no case may the frequency of such tests be more often than once 
        every 2 years.''.
    (b) Frequency.--Section 1862(a)(1) (42 U.S.C. 1395y(a)(1)) is 
amended--
            (1) in subparagraph (H), by striking ``and'' at the end;
            (2) in subparagraph (I), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(J) in the case of a cardiovascular screening test which 
        is performed more frequently than is covered under section 
        1861(ww)(5)(B).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to tests furnished on or after January 1, 2004.

SEC. 107. COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES FOR 
              BENEFICIARIES WITH CARDIOVASCULAR DISEASES.

    (a) In General.--Section 1861(s)(2)(V) (42 U.S.C. 1395x(s)(2)(V)) 
is amended to read as follows:
            ``(V) medical nutrition therapy services (as defined in 
        subsection (vv)(1)) in the case of a beneficiary--
                    ``(i) with a cardiovascular disease (including 
                congestive heart failure, arteriosclerosis, 
                hyperlipidemia, hypertension, and 
                hypercholesterolemia), diabetes, or a renal disease (or 
                a combination of such conditions) who--
                            ``(I) has not received diabetes outpatient 
                        self-management training services within a time 
                        period determined by the Secretary;
                            ``(II) is not receiving maintenance 
                        dialysis for which payment is made under 
                        section 1881; and
                            ``(III) meets such other criteria 
                        determined by the Secretary after consideration 
                        of protocols established by dietitian or 
                        nutrition professional organizations; or
                    ``(ii) with a combination of such conditions who--
                            ``(I) is not described in clause (i) 
                        because of the application of subclause (I) or 
                        (II) of such clause;
                            ``(II) receives such medical nutrition 
                        therapy services in a coordinated manner (as 
                        determined appropriate by the Secretary) with 
                        any services described in such subclauses that 
                        the beneficiary is receiving; and
                            ``(III) meets such other criteria 
                        determined by the Secretary after consideration 
                        of protocols established by dietitian or 
                        nutrition professional organizations,
        for such number of hours as the Secretary may specify, except 
        that, in the case of a beneficiary with a cardiovascular 
        disease, such number may not exceed 3 hours in a year without a 
        determination of a physician that additional hours are 
        medically necessary in that year due to a change in medical 
        condition, diagnosis, or treatment regime of the patient;''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to services furnished on or after January 1, 2004.

SEC. 108. MEDICARE COVERAGE OF DIABETES LABORATORY DIAGNOSTIC TESTS.

    (a) Coverage.--Section 1861(ww) (42 U.S.C. 1395x(ww)), as amended 
by section 107(a), is amended by adding at the end the following new 
paragraph:
            ``(7)(A) Diabetes screening tests (as defined in 
        subparagraph (B)(i)) for individuals at risk for diabetes (as 
        defined in subparagraph (B)(ii)) not more frequently than is 
        covered under subparagraph (C).
            ``(B)(i) For purposes of this paragraph, the term `diabetes 
        screening tests' means diagnostic testing furnished to an 
        individual at risk for diabetes for the purpose of early 
        detection of diabetes, including--
                    ``(I) a fasting plasma glucose test; and
                    ``(II) such other tests, and modifications to 
                tests, as the Secretary determines appropriate, in 
                consultation with appropriate organizations.
            ``(ii) For purposes of this paragraph, the term `individual 
        at risk for diabetes' means an individual who has any of the 
        following risk factors for diabetes:
                    ``(I) A family history of diabetes.
                    ``(II) Overweight defined as a body mass index 
                greater than or equal to 25 kg/m\2\.
                    ``(III) Habitual physical inactivity.
                    ``(IV) Belonging to a high-risk ethnic or racial 
                group.
                    ``(V) Previous identification of an elevated 
                impaired fasting glucose.
                    ``(VI) Identification of impaired glucose 
                tolerance.
                    ``(VII) Hypertension.
                    ``(VIII) Dyslipidemia.
                    ``(IX) History of gestational diabetes mellitus or 
                delivery of a baby weighing greater than 9 pounds.
                    ``(X) Polycystic ovary syndrome.
            ``(C) The Secretary shall establish standards, in 
        consultation with appropriate organizations, regarding the 
        frequency of diabetes screening tests, except that such 
        frequency may not be more often than twice within the 12-month 
        period following the date of the most recent diabetes screening 
        test of that individual.''.
    (b) Frequency.--Section 1862(a)(1) (42 U.S.C. 1395y(a)(1)), as 
amended by section 107(b), is amended--
            (1) in subparagraph (J), by striking ``and'' at the end;
            (2) in subparagraph (K), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(L) in the case of a diabetes screening test (as defined 
        in section 1861(ww)(7)(B)(i)), which is performed more 
        frequently than is covered under section 1861(ww)(7)(C).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to tests furnished on or after January 1, 2004.

SEC. 109. COVERAGE OF ANNUAL SCREENING PAP SMEAR AND PELVIC EXAMS.

    (a) In General.--
            (1) Annual screening pap smear.--Section 1861(nn)(1) (42 
        U.S.C. 1395x(nn)(1)) is amended by striking ``, if the 
        individual involved'' and all that follows before the period at 
        the end and inserting ``if the woman involved has not had such 
        a test during the preceding year''.
            (2) Annual screening pelvic exam.--Section 1861(nn)(2) (42 
        U.S.C. 1395x(nn)(2)) is amended by striking ``during the 
        preceding 2 years, or during the preceding year in the case of 
        a woman described in paragraph (3),'' and inserting ``during 
        the preceding year,''.
            (3) Conforming amendment.--Section 1861(nn) (42 U.S.C. 
        1395x(nn)) is amended by striking paragraph (3).
    (b) Effective Date.--The amendments made by subsection (a) apply to 
items and services furnished on or after January 1, 2004.

SEC. 110. ADJUSTMENTS TO LOCAL FEE SCHEDULES FOR CLINICAL LABORATORY 
              TESTS FOR IMPROVEMENT IN CERVICAL CANCER DETECTION.

    Section 1833(h)(2) (42 U.S.C. 1395l(h)(2)) is amended by adding at 
the end the following new subparagraph:
    ``(C) Notwithstanding any other provision of law, in the case of a 
diagnostic test for the detection of cervical cancer utilizing 
automated thin layer preparation techniques for specimens collected in 
fluid medium, and for which a national limitation amount has been set 
pursuant to the parenthetical in paragraph (4)(B)(viii), furnished on 
or after January 1, 2004, and before January 1, 2006, the Secretary 
shall permit carriers to raise their local fee schedule amount for 
purposes of determining payment for such tests under this section, up 
to, but not to exceed the national limitation amount previously 
established for that test. Any such adjustment shall not affect such 
national limitation amount.''.

SEC. 111. ENHANCED REIMBURSEMENT UNDER THE MEDICARE PROGRAM FOR 
              SCREENING AND DIAGNOSTIC MAMMOGRAPHY SERVICES; NOT 
              COUNTING CERTAIN RADIOLOGY RESIDENTS AGAINST GRADUATE 
              MEDICAL EDUCATION LIMITATIONS.

    (a) Payments to Facilities for Screening and Diagnostic 
Mammography.--
            (1) In general.--Notwithstanding any other provision of 
        law, with respect to payment for a screening or diagnostic 
        mammography furnished to a medicare beneficiary, the amount of 
        payment made to a hospital-based facility (as defined in 
        paragraph (4)) in which such screening or diagnostic 
        mammography is performed during the applicable period described 
        in paragraph (3) is equal to 200 percent of the amount of 
        payment that would otherwise apply under the fee schedule 
        established under section 1848 of the Social Security Act (42 
        U.S.C. 1395w-4) with respect to the technical component of such 
        screening or diagnostic mammography.
            (2) Temporary payment rule.--With respect to payments to a 
        hospital-based facility for screening or diagnostic mammography 
        described in paragraph (1) during the applicable period, 
        payment shall be made to the facility for such mammography 
        pursuant to this subsection and shall not be made under section 
        1833(t) of such Act (42 U.S.C. 1395l(t)).
            (3) Applicable period.--The applicable period referred to 
        in paragraph (1) is the period beginning on the date of 
        enactment of this Act and ending on the date the Secretary 
        establishes and implements an appropriate facility payment rate 
        under the prospective payment system for covered outpatient 
        services under such section 1833(t) for a screening or 
        diagnostic mammography furnished to a medicare beneficiary, but 
        in no case less than the amount payment provided for in 
        paragraph (1).
            (4) Hospital-based facility defined.--In this subsection, 
        the term ``hospital-based facility'' means a facility for which 
        payment is made for a diagnostic or screening mammography under 
        such section 1833(t) but for this subsection.
    (b) Not Counting Certain Radiology Residents Against Graduate 
Medical Education Limitations.--
            (1) In general.--For cost reporting periods beginning on or 
        after October 1, 2003, and before October 1, 2008, in applying 
        the limitations regarding the total number of full-time 
        equivalent residents in the field of allopathic or osteopathic 
        medicine under subsections (d)(5)(B)(v) and (h)(4)(F) of 
        section 1886 of the Social Security Act (42 U.S.C. 1395ww) for 
        a hospital, the Secretary of Health and Human Services shall 
        not take into account 1 additional resident in the field of 
        radiology per post-graduate year during each such cost 
        reporting period to the extent the hospital increases the 
        number of radiology residents above the number of such 
        residents for the hospital's most recent cost reporting period 
        ending before October 1, 2003.
            (2) Treatment for entire period of training program.--The 
        provisions of paragraph (1) shall apply for each year of the 
        full-time equivalent resident's approved medical residency 
        training program in the field of radiology not taken into 
        account by reason of paragraph (1).
    (c) Construction.--Nothing in this section shall be construed as 
affecting the provisions of section 104(d) of the Medicare, Medicaid, 
and SCHIP Benefits Improvement and Protection Act of 2000 (114 Stat. 
2763A-470), as enacted into law by section 1(a)(6) of Public Law 106-
554 (relating to payment for new technologies).

SEC. 112. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR EXISTING 
              PREVENTIVE HEALTH BENEFITS.

    (a) In General.--Section 1833 (42 U.S.C. 1395l) is amended by 
inserting after subsection (o) the following new subsection:
    ``(p) Deductibles and Coinsurance Waived for Preventive Health 
Items and Services.--The Secretary may not require the payment of any 
deductible or coinsurance under subsection (a) or (b), respectively, of 
any individual enrolled for coverage under this part for any of the 
following preventive health items and services:
            ``(1) Blood-testing strips, lancets, and blood glucose 
        monitors for individuals with diabetes described in section 
        1861(n).
            ``(2) Diabetes outpatient self-management training services 
        (as defined in section 1861(qq)(1)).
            ``(3) Pneumococcal, influenza, and hepatitis B vaccines and 
        administration described in section 1861(s)(10).
            ``(4) Screening mammography (as defined in section 
        1861(jj)).
            ``(5) Screening pap smear and screening pelvic exam (as 
        defined in paragraphs (1) and (2) of section 1861(nn), 
        respectively).
            ``(6) Bone mass measurement (as defined in section 
        1861(rr)(1)).
            ``(7) Prostate cancer screening test (as defined in section 
        1861(oo)(1)).
            ``(8) Colorectal cancer screening test (as defined in 
        section 1861(pp)(1)).
            ``(9) Screening for glaucoma (as defined in section 
        1861(uu)).
            ``(10) Medical nutrition therapy services (as defined in 
        section 1861(vv)(1)).''.
    (b) Waiver of Coinsurance.--
            (1) In general.--Section 1833(a)(1)(B) (42 U.S.C. 
        1395l(a)(1)(B)) is amended to read as follows:
                    ``(B) with respect to preventive health items and 
                services described in subsection (p), the amounts paid 
                shall be 100 percent of the fee schedule or other basis 
                of payment under this title for the particular item or 
                service,''.
            (2) Elimination of coinsurance in outpatient hospital 
        settings.--The third sentence of section 1866(a)(2)(A) (42 
        U.S.C. 1395cc(a)(2)(A)), as amended by section 101(c)(3), is 
        amended by inserting ``preventive health items and services 
        described in section 1833(p) and'' before ``supplemental 
        preventive health services''.
    (c) Waiver of Application of Deductible.--Section 1833(b)(1) (42 
U.S.C. 1395l(b)(1)) is amended to read as follows:
            ``(1) such deductible shall not apply with respect to 
        preventive health items and services described in subsection 
        (p),''.
    (d) Adding ``Lancet'' to Definition of DME.--Section 1861(n) (42 
U.S.C. 1395x(n)) is amended by striking ``blood-testing strips and 
blood glucose monitors'' and inserting ``blood-testing strips, lancets, 
and blood glucose monitors''.
    (e) Conforming Amendments.--
            (1) Elimination of coinsurance for clinical diagnostic 
        laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of 
        section 1833(a) (42 U.S.C. 1395l(a)) are each amended by 
        inserting ``or which are described in subsection (p)'' after 
        ``assignment-related basis''.
            (2) Elimination of coinsurance for certain dme.--Section 
        1834(a)(1)(A) (42 U.S.C. 1395m(a)(1)(A)) is amended by 
        inserting ``(or 100 percent, in the case of such an item 
        described in section 1833(p))'' after ``80 percent''.
            (3) Elimination of deductibles and coinsurance for 
        colorectal cancer screening tests.--Section 1834(d) (42 U.S.C. 
        1395m(d)) is amended--
                    (A) in paragraph (2)(C)--
                            (i) by striking ``(C) Facility payment 
                        limit.--'' and all that follows through 
                        ``Notwithstanding subsections'' and inserting 
                        the following:
                    ``(C) Facility payment limit.--Notwithstanding 
                subsections'';
                            (ii) by striking ``(I) in accordance'' and 
                        inserting the following:
                            ``(i) in accordance'';
                            (iii) by striking ``(II) are performed'' 
                        and all that follows through ``payment under'' 
                        and inserting the following:
                            ``(ii) are performed in an ambulatory 
                        surgical center or hospital outpatient 
                        department, payment under''; and
                            (iv) by striking clause (ii); and
                    (B) in paragraph (3)(C)--
                            (i) by striking ``(C) Facility payment 
                        limit.--'' and all that follows through 
``Notwithstanding subsections'' and inserting the following:
                    ``(C) Facility payment limit.--Notwithstanding 
                subsections''; and
                            (ii) by striking clause (ii).
    (f) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2004.

 TITLE II--IMPROVING MEDICARE FOR FAMILY CAREGIVERS BY COVERING ADULT 
                              DAY SERVICES

SEC. 201. FINDINGS.

    Congress finds that--
            (1) adult day services offers services, including medical 
        care, rehabilitation therapies, dignified assistance with 
        activities of daily living, social interaction, and stimulating 
        activities, to seniors who are frail, physically challenged, or 
        cognitively impaired;
            (2) access to adult day services provides seniors and their 
        familial caregivers support that is critical to keeping the 
        senior in the family home;
            (3) more than 22,000,000 families in the United States 
        serve as caregivers for aging or ailing seniors, nearly 1 in 4 
        American families, providing close to 80 percent of the care to 
        individuals requiring long-term care;
            (4) nearly 75 percent of those actively providing such care 
        are women who also maintain other responsibilities, such as 
        working outside of the home and raising young children;
            (5) the average loss of income to these caregivers has been 
        shown to be $659,130 in wages, pension, and Social Security 
        benefits;
            (6) the loss in productivity in United States businesses 
        ranges from $11,000,000,000 to $29,000,000,000 annually;
            (7) the services offered in adult day services facilities 
        provide continuity of care and an important sense of community 
        for both the senior and the caregiver;
            (8) there are adult day services facilities in every State 
        in the United States and the District of Columbia;
            (9) these centers generally offer transportation, meals, 
        personal care, and counseling in addition to the medical 
        services and socialization benefits offered; and
            (10) with the need for quality options in how to best care 
        for our senior population about to dramatically increase with 
        the aging of the baby boomer generation, the time to address 
        these issues is now.

SEC. 202. MEDICARE COVERAGE OF SUBSTITUTE ADULT DAY SERVICES.

    (a) Substitute Adult Day Services Benefit.--
            (1) In general.--Section 1861(m) of the Social Security Act 
        (42 U.S.C. 1395x(m)) is amended--
                    (A) in the matter preceding paragraph (1), by 
                inserting ``or (8)'' after ``paragraph (7)'';
                    (B) in paragraph (6), by striking ``and'' at the 
                end;
                    (C) in paragraph (7), by adding ``and'' at the end; 
                and
                    (D) by inserting after paragraph (7), the following 
                new paragraph:
            ``(8) substitute adult day services (as defined in 
        subsection (ww));''.
            (2) Substitute adult day services defined.--Section 1861 of 
        the Social Security Act (42 U.S.C. 1395x) is amended by adding 
        at the end the following new subsection:

      ``Substitute Adult Day Services; Adult Day Services Facility

    ``(ww)(1)(A) The term `substitute adult day services' means the 
items and services described in subparagraph (B) that are furnished to 
an individual by an adult day services facility as a part of a plan 
under subsection (m) that substitutes such services for some or all of 
the items and services described in subparagraph (B)(i) furnished by a 
home health agency under the plan, as determined by the physician 
establishing the plan.
    ``(B) The items and services described in this subparagraph are the 
following items and services:
            ``(i) Items and services described in paragraphs (1) 
        through (7) of subsection (m).
            ``(ii) Meals.
            ``(iii) A program of supervised activities designed to 
        promote physical and mental health and furnished to the 
individual by the adult day services facility in a group setting for a 
period of not fewer than 4 and not greater than 12 hours per day.
            ``(iv) A medication management program (as defined in 
        subparagraph (C)).
    ``(C) For purposes of subparagraph (B)(iv), the term `medication 
management program' means a program of services, including medicine 
screening and patient and health care provider education programs, that 
provides services to minimize--
            ``(i) unnecessary or inappropriate use of prescription 
        drugs; and
            ``(ii) adverse events due to unintended prescription drug-
        to-drug interactions.
    ``(2)(A) Except as provided in subparagraphs (B) and (C), the term 
`adult day services facility' means a public agency or private 
organization, or a subdivision of such an agency or organization, 
that--
            ``(i) is engaged in providing skilled nursing services and 
        other therapeutic services directly or under arrangement with a 
        home health agency;
            ``(ii) provides the items and services described in 
        paragraph (1)(B); and
            ``(iii) meets the requirements of paragraphs (2) through 
        (8) of subsection (o).
    ``(B) Notwithstanding subparagraph (A), the term `adult day 
services facility' shall include a home health agency in which the 
items and services described in clauses (ii) through (iv) of paragraph 
(1)(B) are provided--
            ``(i) by an adult day services program that is licensed or 
        certified by a State, or accredited, to furnish such items and 
        services in the State; and
            ``(ii) under arrangements with that program made by such 
        agency.
    ``(C) The Secretary may waive the requirement of a surety bond 
under paragraph (7) of subsection (o) in the case of an agency or 
organization that provides a comparable surety bond under State law.''.
    (b) Payment for Substitute Adult Day Services.--Section 1895 of the 
Social Security Act (42 U.S.C. 1395fff) is amended by adding at the end 
the following new subsection:
    ``(f) Payment Rate for Substitute Adult Day Services.--
            ``(1) Payment rate.--For purposes of making payments to an 
        adult day services facility for substitute adult day services 
        (as defined in section 1861(ww)), the following rules shall 
        apply:
                    ``(A) Estimation of payment amount.--The Secretary 
                shall estimate the amount that would otherwise be 
                payable to a home health agency under this section for 
                all home health services described in paragraph 
                (1)(B)(i) of such section under the plan of care.
                    ``(B) Amount of payment.--Subject to paragraph 
                (3)(B), the total amount payable for substitute adult 
                day services under the plan of care is equal to 95 
                percent of the amount estimated to be payable under 
                subparagraph (A).
            ``(2) Limitation on balance billing.--An adult day services 
        facility shall accept as payment in full for substitute adult 
        day services (including those services described in clauses 
        (ii) through (iv) of section 1861(ww)(1)(B)) furnished by the 
        facility to an individual entitled to benefits under this title 
        the amount of payment provided under this subsection for home 
        health services consisting of substitute adult day services.
            ``(3) Adjustment in case of overutilization of substitute 
        adult day services.--
                    ``(A) Monitoring expenditures.--Beginning with 
                fiscal year 2005, the Secretary shall monitor the 
                expenditures made under this title for home health 
                services, including such services consisting of 
                substitute adult day services, for the fiscal year and 
                shall compare such expenditures to expenditures that 
                the Secretary estimates would have been made under this 
                title for home health services for the fiscal year if 
                the Improving Women's Health Act of 2003 had not been 
                enacted.
                    ``(B) Required reduction in payment rate.--If the 
                Secretary determines, after making the comparison under 
                subparagraph (A) and making such adjustments for 
                changes in demographics and age of the medicare 
                beneficiary population as the Secretary determines 
                appropriate, that expenditures for home health services 
                under the this title, including such services 
                consisting of substitute adult day services, for the 
                fiscal year exceed expenditures that would have been 
                made under this title for home health services for the 
                fiscal year if the Improving Women's Health Act of 2003 
                not been enacted, then the Secretary shall adjust the 
                rate of payment to adult day services facilities under 
                paragraph (1)(B) for home health services consisting of 
                substitute adult day services furnished in the fiscal 
                year in order to eliminate such excess.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2004.

 TITLE III--IMPROVING AND EXPANDING PRENATAL CARE FOR LOW-INCOME WOMEN

SEC. 301. 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) 
        (42 U.S.C. 1396a(l)(2)(A)(i)) is amended by inserting ``(or 
        such higher percentage 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 (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 new paragraph:
    ``(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, 2003, 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) (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 new subparagraph:
                    ``(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 (42 U.S.C. 1397aa et seq.) is 
        amended by adding at the end the following new section:

``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, 2003, 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 (42 U.S.C. 1397dd) is 
                amended by inserting after subsection (c) the following 
                new subsection:
    ``(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 2004 through 
        2007, $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, 2003. 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, 2003.''.
                    (B) Conforming amendments.--Section 2104 (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) (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) (42 
                U.S.C. 1397bb(b)(1)(B)) is amended--
                            (i) in clause (i), by striking ``, and'' at 
                        the end and inserting a semicolon;
                            (ii) in clause (ii), by striking the period 
                        at the end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(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) (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) 
        (42 U.S.C. 1396r-1(b)) is amended by adding after 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, 2003, without 
regard to whether regulations implementing such amendments have been 
promulgated.

SEC. 302. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID 
              PROGRAM AND SCHIP.

    (a) Medicaid Program.--Section 1903(v) (42 U.S.C. 1396b(v)) is 
amended--
            (1) in paragraph (1), by striking ``paragraph (2)'' and 
        inserting ``paragraphs (2) and (4)''; and
            (2) by adding at the end the following new paragraph:
    ``(4)(A) A State may elect (in a plan amendment under this title) 
to provide medical assistance under this title for aliens who are 
lawfully residing in the United States (including battered aliens 
described in section 431(c) of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996) and who are otherwise eligible 
for such assistance, within any of the following eligibility 
categories:
            ``(i) Pregnant women.--Women during pregnancy (and during 
        the 60-day period beginning on the last day of the pregnancy).
            ``(ii) Children.--Children (as defined under such plan), 
        including optional targeted low-income children described in 
        section 1905(u)(2)(B).
    ``(B)(i) In the case of a State that has elected to provide medical 
assistance to a category of aliens under subparagraph (A), no debt 
shall accrue under an affidavit of support against any sponsor of such 
an alien on the basis of provision of assistance to such category and 
the cost of such assistance shall not be considered as an unreimbursed 
cost.
    ``(ii) The provisions of sections 401(a), 402(b), 403, and 421 of 
the Personal Responsibility and Work Opportunity Reconciliation Act of 
1996 shall not apply to a State that makes an election under 
subparagraph (A).''.
    (b) Title XXI.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is 
amended by adding at the end the following new subparagraph:
                    ``(E) Section 1903(v)(4) (relating to optional 
                coverage of permanent resident alien children), but 
                only if the State has elected to apply such section to 
                that category of children under title XIX.''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2003, and apply to medical assistance and child 
health assistance furnished on or after such date.

SEC. 303. PROMOTING CESSATION OF TOBACCO USE UNDER THE MEDICAID 
              PROGRAM.

    (a) Dropping Exception From Medicaid Prescription Drug Coverage for 
Tobacco Cessation Medications.--Section 1927(d)(2) (42 U.S.C. 1396r-
8(d)(2)) is amended--
            (1) by striking subparagraph (E);
            (2) by redesignating subparagraphs (F) through (J) as 
        subparagraphs (E) through (I), respectively; and
            (3) in subparagraph (F) (as redesignated by paragraph (2)), 
        by inserting before the period at the end the following: ``, 
        except agents approved by the Food and Drug Administration for 
        purposes of promoting, and when used to promote, tobacco 
        cessation''.
    (b) Requiring Coverage of Tobacco Cessation Counseling Services for 
Pregnant Women.--Section 1905(a)(4) (42 U.S.C. 1396d(a)(4)) is 
amended--
            (1) by striking ``and'' before ``(C)''; and
            (2) by inserting before the semicolon at the end the 
        following new subparagraph: ``; and (D) counseling for 
        cessation of tobacco use (as defined in section 1861(ww)) for 
        pregnant women''.
    (c) Removal of Cost-Sharing for Tobacco Cessation Counseling 
Services for Pregnant Women.--Section 1916 (42 U.S.C. 1396o) is amended 
in each of subsections (a)(2)(B) and (b)(2)(B) by inserting ``, and 
counseling for cessation of tobacco use (as defined in section 
1861(ww))'' after ``complicate the pregnancy''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the date that is 1 year after 
the date of enactment of this Act.

SEC. 304. PROMOTING CESSATION OF TOBACCO USE UNDER THE MATERNAL AND 
              CHILD HEALTH SERVICES BLOCK GRANT PROGRAM.

    (a) Quality Maternal and Child Health Services Includes Tobacco 
Cessation Counseling and Medications.--Section 501 (42 U.S.C. 701) is 
amended by adding at the end the following new subsection:
    ``(c) For purposes of this title, counseling for cessation of 
tobacco use (as defined in section 1861(vv)), drugs and biologicals 
used to promote smoking cessation, and the inclusion of antitobacco 
messages in health promotion counseling shall be considered to be part 
of quality maternal and child health services.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date that is 1 year after the date of enactment of 
this Act.

SEC. 305. STATE OPTION TO PROVIDE FAMILY PLANNING SERVICES AND SUPPLIES 
              TO INDIVIDUALS WITH INCOMES THAT DO NOT EXCEED A STATE'S 
              INCOME ELIGIBILITY LEVEL FOR MEDICAL ASSISTANCE.

    (a) In General.--Title XIX (42 U.S.C. 1396 et seq.) is amended--
            (1) by redesignating section 1935 as section 1936; and
            (2) by inserting after section 1934 the following new 
        section:

    ``state option to provide family planning services and supplies

    ``Sec. 1935. (a) In General.--Subject to subsections (b) and (c), a 
State may elect (through a State plan amendment) to make medical 
assistance described in section 1905(a)(4)(C) available to any 
individual whose family income does not exceed the greater of--
            ``(1) 185 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
            ``(2) the eligibility income level (expressed as a 
        percentage of such poverty line) that has been specified under 
        a waiver authorized by the Secretary or under section 
        1902(r)(2)), as of October 1, 2003, for an individual to be 
        eligible for medical assistance under the State plan.
    ``(b) Comparability.--Medical assistance described in section 
1905(a)(4)(C) that is made available under a State plan amendment under 
subsection (a) shall--
            ``(1) not be less in amount, duration, or scope than the 
        medical assistance described in that section that is made 
        available to any other individual under the State plan; and
            ``(2) be provided in accordance with the restrictions on 
        deductions, cost sharing, or similar charges imposed under 
        section 1916(a)(2)(D).
    ``(c) Option To Extend Coverage During a Post-Eligibility Period.--
            ``(1) Initial period.--A State plan amendment made under 
        subsection (a) may provide that any individual who was 
        receiving medical assistance described in section 1905(a)(4)(C) 
        as a result of such amendment, and who becomes ineligible for 
        such assistance because of hours of, or income from, 
        employment, may remain eligible for such medical assistance 
        through the end of the 6-month period that begins on the first 
        day the individual becomes so ineligible.
            ``(2) Additional extension.--A State plan amendment made 
        under subsection (a) may provide that any individual who has 
        received medical assistance described in section 1905(a)(4)(C) 
        during the entire 6-month period described in paragraph (1) may 
        be extended coverage for such assistance for a succeeding 6-
        month period.''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
medical assistance provided on and after October 1, 2003.

SEC. 306. STATE OPTION TO EXTEND THE POSTPARTUM PERIOD FOR PROVISION OF 
              FAMILY PLANNING SERVICES AND SUPPLIES.

    (a) In General.--Section 1902(e)(5) (42 U.S.C. 1396a(e)(5)) is 
amended--
            (1) by striking ``eligible under the plan, as though'' and 
        inserting ``eligible under the plan--
            ``(A) as though'';
            (2) by striking the period and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(B) for medical assistance described in section 
        1905(a)(4)(C) for so long as the family income of such woman 
        does not exceed the maximum income level established by the 
        State for the woman to be eligible for medical assistance under 
        the State plan (as a result of pregnancy or otherwise).''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
medical assistance provided on and after October 1, 2003.
                                 <all>