[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2523 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 2523

   To amend title XIX of the Social Security Act to expand access to 
 contraceptive services for women and men under the Medicaid Program, 
 help low income women and couples prevent unintended pregnancies and 
                reduce abortion, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 24, 2007

    Mrs. Lowey (for herself, Ms. DeLauro, Mr. Kirk, and Mr. Waxman) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend title XIX of the Social Security Act to expand access to 
 contraceptive services for women and men under the Medicaid Program, 
 help low income women and couples prevent unintended pregnancies and 
                reduce abortion, 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.

    This Act may be cited as the ``Unintended Pregnancy Reduction Act 
of 2007''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Rates of unintended pregnancy in the United States 
        increased by nearly 30 percent among low-income women between 
        1994 and 2002, and a low-income woman today is 4 times as 
        likely to have an unintended pregnancy as her higher income 
        counterpart.
            (2) Abortion rates decreased among higher income women but 
        increased among low income women between 1994 and 2002, and a 
        low income woman is more than 4 times as likely to have an 
        abortion as her higher income counterpart.
            (3) Contraceptive use reduces a woman's probability of 
        having an abortion by 85 percent.
            (4) Levels of contraceptive use among low-income women at 
        risk of unintended pregnancy declined significantly between 
        1994 and 2002, from 92 percent to 86 percent.
            (5) Publicly funded contraceptive services have been shown 
        to prevent 1,300,000 unintended pregnancies each year, and in 
        the absence of these services the United States abortion rate 
        would likely be 40 percent higher than it is.
            (6) By helping couples avoid unintended pregnancy, 
        Medicaid-funded contraceptive services are highly cost-
        effective, and every public dollar spent on family planning 
        saves $3 in the cost of pregnancy-related care alone.
            (7) Federal law requires State Medicaid programs to cover 
        pregnancy-related care for women with incomes up to 133 percent 
        of poverty, and 17 States have expanded this coverage to women 
        with incomes up to 200 percent of poverty.
            (8) 18 States have expanded Medicaid coverage for family 
        planning services to the same level at which they provide 
        Medicaid funded pregnancy-related care.
            (9) Equalizing the eligibility levels for family planning 
        and pregnancy-related care nationwide would maximize the cost-
        savings to both the Federal and State Governments.
            (10) A woman should have equal access to contraceptive 
        services to help prevent an unintended pregnancy and to 
        pregnancy-related care if she does become pregnant.

SEC. 3. EXPANSION OF FAMILY PLANNING SERVICES.

    (a) Coverage as Mandatory Categorically Needy Group.--
            (1) In general.--Section 1902(a)(10)(A)(i) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(i)) is amended--
                    (A) in subclause (VI), by striking ``or'' at the 
                end;
                    (B) in subclause (VII), by adding ``or'' at the 
                end; and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(VIII) who are described in 
                                subsection (dd) (relating to 
                                individuals who meet the income 
                                standards for pregnant women);''.
            (2) Group described.--Section 1902 of the Social Security 
        Act (42 U.S.C. 1396a) is amended by adding at the end the 
        following new subsection:
    ``(dd)(1) Individuals described in this subsection are individuals 
who--
            ``(A) meet at least the income eligibility standards 
        established under the State plan as of January 1, 2007, for 
        pregnant women or such higher income eligibility standard for 
        such women as the State may establish; and
            ``(B) are not pregnant.
    ``(2) At the option of a State, individuals described in this 
subsection may include individuals who are determined to meet the 
income eligibility standards referred to in paragraph (1)(A) under the 
terms and conditions applicable to making eligibility determinations 
for medical assistance under this title under a waiver to provide the 
benefits described in clause (XV) of the matter following subparagraph 
(G) of section 1902(a)(10) granted to the State under section 1115 as 
of January 1, 2007.''.
            (3) Limitation on benefits.--Section 1902(a)(10) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in the 
        matter following subparagraph (G)--
                    (A) by striking ``and (XIV)'' and inserting 
                ``(XIV)''; and
                    (B) by inserting ``, and (XV) the medical 
                assistance made available to an individual described in 
                subsection (dd) who is eligible for medical assistance 
                only because of subparagraph (A)(10)(i)(VIII) shall be 
                limited to family planning services and supplies 
                described in section 1905(a)(4)(C) including medical 
                diagnosis or treatment  services that are  provided 
                pursuant to a family planning service in a family 
                planning setting provided during the period in which 
                such an individual is eligible;'' after ``cervical 
                cancer''.
            (4) Conforming amendments.--Section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
        preceding paragraph (1)--
                    (A) in clause (xii), by striking ``or'' at the end;
                    (B) in clause (xii), by adding ``or'' at the end; 
                and
                    (C) by inserting after clause (xiii) the following:
                            ``(xiv) individuals described in section 
                        1902(dd),''.
    (b) Presumptive Eligibility.--
            (1) In general.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended by inserting after section 
        1920B the following:

         ``presumptive eligibility for family planning services

    ``Sec. 1920C.  (a) State Option.--A State plan approved under 
section 1902 may provide for making medical assistance available to an 
individual described in section 1902(dd) (relating to individuals who 
meet the income eligibility standard for pregnant women in the State) 
during a presumptive eligibility period. In the case of an individual 
described in section 1902(dd) who is eligible for medical assistance 
only because of subparagraph (A)(10)(i)(VIII), such medical assistance 
may be limited to family planning services and supplies described in 
1905(a)(4)(C) and, at the State's option, medical diagnosis or 
treatment services that are provided in conjunction with a family 
planning service in a family planning setting provided during the 
period in which such an individual is eligible.
    ``(b) Definitions.--For purposes of this section:
            ``(1) Presumptive eligibility period.--The term 
        `presumptive eligibility period' means, with respect to an 
        individual described in subsection (a), the period that--
                    ``(A) begins with the date on which a qualified 
                entity determines, on the basis of preliminary 
                information, that the individual is described in 
                section 1902(dd); and
                    ``(B) ends with (and includes) the earlier of--
                            ``(i) the day on which a determination is 
                        made with respect to the eligibility of such 
                        individual for services under the State plan; 
                        or
                            ``(ii) in the case of such an individual 
                        who does not file an application by the last 
                        day of the month following the month during 
                        which the entity makes the determination 
                        referred to in subparagraph (A), such last day.
            ``(2) Qualified entity.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                term `qualified entity' means any entity that--
                            ``(i) is eligible for payments under a 
                        State plan approved under this title; and
                            ``(ii) is determined by the State agency to 
                        be capable of making determinations of the type 
                        described in paragraph (1)(A).
                    ``(B) Regulations.--The Secretary may issue 
                regulations further limiting those entities that may 
                become qualified entities in order to prevent fraud and 
                abuse and for other reasons.
                    ``(C) Rule of construction.--Nothing in this 
                paragraph shall be construed as preventing a State from 
                limiting the classes of entities that may become 
                qualified entities, consistent with any limitations 
                imposed under subparagraph (B).
    ``(c) Administration.--
            ``(1) In general.--The State agency shall provide qualified 
        entities with--
                    ``(A) such forms as are necessary for an 
                application to be made by an individual described in 
                subsection (a) for medical assistance under the State 
                plan; and
                    ``(B) information on how to assist such individuals 
                in completing and filing such forms.
            ``(2) Notification requirements.--A qualified entity that 
        determines under subsection (b)(1)(A) that an individual 
        described in subsection (a) is presumptively eligible for 
        medical assistance under a State plan shall--
                    ``(A) notify the State agency of the determination 
                within 5 working days after the date on which 
                determination is made; and
                    ``(B) inform such individual at the time the 
                determination is made that an application for medical 
                assistance is required to be made by not later than the 
                last day of the month following the month during which 
                the determination is made.
            ``(3) Application for medical assistance.--In the case of 
        an individual described in subsection (a) who is determined by 
        a qualified entity to be presumptively eligible for medical 
        assistance under a State plan, the individual shall apply for 
        medical assistance by not later than the last day of the month 
        following the month during which the determination is made.
    ``(d) Payment.--Notwithstanding any other provision of this title, 
medical assistance that--
            ``(1) is furnished to an individual described in subsection 
        (a)--
                    ``(A) during a presumptive eligibility period;
                    ``(B) by a entity that is eligible for payments 
                under the State plan; and
            ``(2) is included in the care and services covered by the 
        State plan, shall be treated as medical assistance provided by 
        such plan for purposes of clause (4) of the first sentence of 
        section 1905(b).''.
            (2) Conforming amendments.--
                    (A) Section 1902(a)(47) of the Social Security Act 
                (42 U.S.C. 1396a(a)(47)) is amended by inserting before 
                the semicolon at the end the following: ``and provide 
                for making medical assistance available to individuals 
                described in subsection (a) of section 1920C during a 
                presumptive eligibility period in accordance with such 
                section.''.
                    (B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 
                1396b(u)(1)(D)(v)) is amended--
                            (i) by striking ``or for'' and inserting 
                        ``, for''; and
                            (ii) by inserting before the period the 
                        following: ``, or for medical assistance 
                        provided to an individual described in 
                        subsection (a) of section 1920C during a 
                        presumptive eligibility period under such 
                        section''.

SEC. 4. CLARIFICATION OF COVERAGE OF FAMILY PLANNING SERVICES AND 
              SUPPLIES.

    Section 1937(b) of the Social Security Act (42 U.S.C. 1396u-7(b)) 
is amended by adding at the end the following:
            ``(5) Coverage of family planning services and supplies.--
        Notwithstanding the previous provisions of this section, a 
        State may not provide for medical assistance through enrollment 
        of an individual with benchmark coverage or benchmark-
        equivalent coverage under this section unless such coverage 
        includes for any individual described in section 1905(a)(4)(C), 
        medical assistance for family planning services and supplies in 
        accordance with such section.''.

SEC. 5. EFFECTIVE DATE.

    (a) In General.--Except as provided in paragraph (2), the 
amendments made by this Act take effect on October 1, 2007.
    (b) Extension of Effective Date for State Law Amendment.--In the 
case of a State plan under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) which the Secretary of Health and Human Services 
determines requires State legislation in order for the plan to meet the 
additional requirements imposed by the amendments made by this Act, the 
State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
these additional requirements before the first day of the first 
calendar quarter beginning after the close of the first regular session 
of the State legislature that begins after the date of enactment of 
this Act. For purposes of the previous sentence, in the case of a State 
that has a 2-year legislative session, each year of the session is 
considered to be a separate regular session of the State legislature.
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