Optional medicaid coverage of certain prostate cancer patients

(a)

Coverage as optional categorically needy group

(1)

In general

Section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended— (A)in subclause (XVIII), by striking or at the end; (B)in subclause (XIX), by adding or at the end; and (C)by adding at the end the following:

(XX)who are described in subsection (dd) (relating to certain prostate cancer patients);

(2)

Group described

Section 1902 of such Act (42 U.S.C. 1396a) is amended by adding at the end the following:

(dd)Individuals described in this paragraph are individuals who— (1)are not described in subsection (a)(10)(A)(i); (2)have not attained age 65; (3)have been screened for prostate cancer under section 317D of the Public Health Service Act (42 U.S.C. 247b–5), or any other prostate cancer screening program supported with Federal funds, and need treatment for prostate cancer; (4)are in families whose income does not exceed 250 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved; and (5)are not otherwise covered under creditable coverage, as defined in section 2701(c) of the Public Health Service Act (45 U.S.C. 300gg(c)).

(3)

Limitation on benefits

Section 1902(a)(10) of such 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 (aa) who is eligible for medical assistance only because of subparagraph (A)(10)(ii)(XX) shall be limited to medical assistance provided during the period in which such an individual requires treatment for prostate cancer before the semicolon. (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 (xiii), 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:

1920C.

Presumptive eligibility for certain prostate cancer patients

(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 certain prostate cancer patients) during a presumptive eligibility period. (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 under the State plan 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 under such plan 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 an 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 section 1903(a)(5)(B).

(2)

Conforming amendments

(A)Section 1902(a)(47) of the Social Security Act (42 U.S.C. 1396a(a)(47)) is amended— (i)by striking and provide and inserting , provide; and (ii)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. (c)

Enhanced match

Section 1903(a)(5) of the Social Security Act (42 U.S.C. 1396b(a)(5)) is amended— (1)by striking an and inserting (A) an; (2)by adding plus after the semicolon; and (3)by adding at the end the following:

(B)an amount equal to 75 percent of the sums expended during such quarter which are attributable to the offering, arranging, and furnishing (directly or on a contract basis) of prostate cancer-related treatment services; plus

(d)

Effective date

The amendments made by this section apply to medical assistance furnished on or after the date of the enactment of this Act, without regard to whether final regulations to carry out such amendments have been promulgated by such date.