Short title

This Act may be cited as the

Hurricane Katrina Medicaid and SCHIP Relief Act of 2005

Definitions

In this Act: (1)

Disaster period

(A)

In general

Subject to subparagraph (B), the term disaster period means, with respect to any State that includes an area for which a major disaster has been declared in accordance with section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170) as a result of Hurricane Katrina, the period beginning on the earliest date on which any area of the State was so declared and ending on the earlier of— (i)the latest date for which any such declaration of an area of the State terminates; or (ii)6 months after the beginning of such period. (B)

One-time extension

The President may extend the disaster period under subparagraph (A) with respect to a State for a period of up to 6 months. Any reference to the term disaster period in this Act shall include any extension under this subparagraph. (2)

Katrina Survivor

(A)

In general

The term Katrina Survivor means individuals who— (i)reside in an area for which a major disaster has been declared in accordance with 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170) as a result of Hurricane Katrina; or (ii)resided in such an area on any day during the week preceding the date that the major disaster was declared with respect to that area. (B)

Treatment of homeless persons

In the case of an individual who was homeless within an area described in subparagraph (A) on any day during the week preceding the date on which a major disaster for such area was first declared, the individual’s residence shall be deemed to be the place of residence as otherwise determined for such an individual under title XIX or XXI (as the case may be) of the Social Security Act.

Authority to provide medical assistance under Medicaid or child health assistance under the State children’s health insurance program to Katrina Survivors

During the disaster period, any State may provide medical assistance under a State Medicaid plan established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), without submitting a State plan amendment, to Katrina Survivors, or, in the case of a Katrina Survivor who is a child, child health assistance under a State child health plan under title XXI of such Act (42 U.S.C. 1397aa et seq.), in accordance with the following: (1)

Uniform eligibility rules

(A)

No income, resources, residency, or categorical eligibility requirements

Such assistance shall be provided without application of any income or resources test, State residency, or categorical eligibility requirements. (B)

Streamlined eligibility procedures

The State shall use the following streamlined procedures in processing applications and determining eligibility for medical or child health assistance for Katrina Survivors: (i)A common 1-page application form that shall include notice regarding the penalties for making a fraudulent application under paragraph (4) and shall require the applicant to assign to the State any rights of the applicant (or any other person who is a Katrina Survivor and on whose behalf the applicant has the legal authority to execute an assignment of such rights) under any group health plan or other third-party coverage for health care. (ii)Self-attestation by (or in the case of a child, on behalf of) the applicant that the applicant is a Katrina Survivor. (iii)No requirement for documentation evidencing the basis on which the applicant qualifies to be a Katrina Survivor. (iv)Issuance of an eligibility card to an applicant who completes such application, including the self-attestation required under clause (ii). Such card shall be valid during the disaster period. (v)If an applicant completes the application and presents it to a provider or facility participating in the State Medicaid plan or the State child health plan that is qualified to make presumptive eligibility determinations under such plan (which at a minimum shall consist of facilities identified in section 1902(a)(55) of the Social Security Act (42 U.S.C. 1396a(a)(55)) and it appears to the provider that the applicant is a Katrina Survivor based on the information in the application, the applicant will be deemed to be a Katrina Survivor eligible for medical or child health assistance in accordance with this section, subject to paragraph (3). (vi)Subject to paragraphs (3) and (4), continuous eligibility, without the need for any redetermination of eligibility, for the duration of the disaster period. (2)

Scope of coverage same as categorically needy or targeted low-income child

(A)

In general

The State shall treat a Katrina Survivor as an individual eligible for medical assistance under the State plan under title XIX of the Social Security Act on the basis of section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)), or, in the case of a child, as a targeted low-income child under the State child health plan under title XXI of such Act (42 U.S.C. 1397aa et seq.), with coverage for such assistance retroactive to the earliest date described in section 2(1) that is applicable to such Survivor. (B)

Reimbursement of items and services that a provider determines are medically necessary

The State shall pay a provider of medical or child health assistance (including a provider of mental health services) for an item or service provided by the provider to a Katrina Survivor which is not within the scope of coverage applicable to the Survivor under subparagraph (A) upon a determination by the provider that the provision of such item or service is medically necessary for the Survivor (without regard to the State’s standard which would otherwise apply to a determination of medical necessity). (3)

Verification of status as a Katrina Survivor

(A)

In general

The State shall make a good faith effort to verify the status of a Katrina Survivor enrolled in the State Medicaid or child health plan under the provisions of this section after the determination of the eligibility of the Survivor for medical or child health assistance under such plan. (B)

Evidence of verification

A State may satisfy the verification requirement under subparagraph (A) with respect to a Katrina Survivor by showing that the State providing medical or child assistance obtained information from the Social Security Administration, the Internal Revenue Service, or, in the case of a Katrina Survivor who resided in a State for which a major disaster has been declared in accordance with 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170) as a result of Hurricane Katrina, the State Agency for that State with responsibility for administering that State’s Medicaid or child health plan. (C)

Disallowance of payments for failure to make good faith effort

If, with respect to the status of a Katrina Survivor enrolled in a State Medicaid or child health plan, the State fails to make the good faith effort required under subparagraph (A), and the Secretary determines that the individual so enrolled is not a Katrina Survivor, the Secretary shall disallow all Federal payments made to the State that are directly attributable to medical or child health assistance provided or administrative costs incurred with respect to the individual during the disaster period. (4)

Penalty for fraudulent applications

(A)

Individual liable for COSTS

If a State, as the result of verification activities conducted under paragraph (3), determines that an individual has knowingly made a false self-attestation described in paragraph (1)(B)(ii), the State may, subject to subparagraph (B), seek recovery from the individual for the full amount of the cost of medical assistance provided to the individual under this section. The recovery of such amount shall be in addition to any other penalties that may be prescribed by law. (B)

Exception

The Secretary shall exempt a State from seeking recovery under subparagraph (A) if the Secretary determines that it would not be cost-effective for the State to do so. (C)

Reimbursement to the Federal government

Any amounts recovered by a State in accordance with this paragraph shall be returned to the Federal Government, except that a State’s administrative costs attributable to obtaining such recovery shall be reimbursed by the Federal Government in accordance with section 4. (5)

Exemption from error rate penalties

All payments attributable to providing medical assistance to Katrina Survivors in accordance with this section shall be disregarded for purposes of section 1903(u) of the Social Security Act (42 U.S.C. 1396b(u)).

100 percent federal financial assistance for medical and child health assistance and administrative costs

Notwithstanding sections 1903(a), 1905(b), and 2105(b) of the Social Security Act (42 U.S.C. 1396b(a), 1396d(b), 1397ee(b)), the Federal medical assistance percentage (or the enhanced FMAP, in the case of section 2105(b) of such Act) for providing medical assistance under a State Medicaid plan under title XIX of such Act or child health assistance under a State child health plan to a Katrina Survivor, and for costs directly attributable to all administrative activities related to the provision of such assistance, shall be 100 percent during the disaster period applicable to the area of residence (or former residence) of such a Survivor.

Accommodation of special needs of Katrina Survivors under medicare program

(a)

Exclusion of Disaster Relief Period in Computing Part B Late Enrollment Penalty

In applying the first sentence of section 1839(b) of the Social Security Act (42 U.S.C. 1395r(b)) in the case of a Katrina Survivor, there shall not be taken into account any month any part of which is within the disaster period or within the 2-month period following the end of such disaster period. (b)

Part D

(1)

Extension of initial enrollment period

In the case of a Katrina Survivor, the initial enrollment period under section 1860D–1(b)(2) of the Social Security Act (42 U.S.C. 1395w–101(b)(2)) shall in no case end before May 15, 2007. (2)

Flexibility in documentation for low-income subsidies

For purposes of carrying out section 1860D–14 of the Social Security Act (42 U.S.C. 1395w–114), with respect to Katrina Survivors, the Secretary of Health and Human Services shall establish documentation rules for Katrina Survivors which take into account the loss and unavailability of documents due to Hurricane Katrina.

General provisions

(a)

Authority to rely on website posted designations

The Secretary of Health and Human Services shall post on the Internet website for the Centers for Medicare & Medicaid Services a list of areas, including parishes and counties, identified as areas for which a major disaster has been declared in accordance with section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170) as a result of Hurricane Katrina. Any State which provides medical or child health assistance to Katrina Survivors on the basis of such posting and in accordance with this Act shall be held harmless if it is subsequently determined that the provision of such assistance was in error. (b)

Emergency designation

The preceding provisions of this Act are hereby designated as emergency requirements pursuant to subsections (a) and (b) of section 402 of H. Con. Res. 95 (109th Congress).