[Congressional Record Volume 142, Number 143 (Monday, October 21, 1996)]
[Senate]
[Pages S12467-S12468]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       CHILDREN'S HEALTH INSURANCE FOR LONG-TERM DEVELOPMENT ACT

 Mr. KERREY. Mr. President, on September 30, 1996, I introduced 
S. 2167, the Children's Health Insurance for Long-Term Development 
Act--the CHILD bill. In simple terms, this legislation will require 
private health plans to cover all necessary health and screening 
services for infants and children through age 3. But it has a broader 
purpose. It will close the gap between two entities that serve 
America's children, the health system and the school system, by 
addressing an important health risk that has implications for 
children's education achievements and later development.
  A significant body of research demonstrates that the first 3 years of 
life are critical to children's development--mentally, physically, and 
emotionally. In particular, during the first 3 years of life the human 
brain and central nervous system undergo their most rapid period of 
neurological development. This time period--the infant neurological 
risk exposure period--provides both a substantial risk and an important 
opportunity. If we can ensure that children receive the health care, 
parenting and environmental influences they need during their first 3 
years, we can give our children a strong start in life. If, however, we 
neglect their physical and mental development during this crucial 
period, we have lost an important opportunity to promote learning and 
prevent damage to brain functioning.
  Obviously, there are many influences on a child's early development, 
such as parental influence and childrearing practices, comprehensive 
health care, environment, mental stimulation, and community support. As 
a Nation, we have an opportunity and an obligation to provide children 
with a safe, healthy, stimulating environment during their early years. 
This bill takes an important step toward this goal.
  First, this legislation identifies a critical period in children's 
development--the Infant Neurological Risk Exposure Period [INREP]. 
Brain and nervous system development during this period has a long-
lasting impact on the child's life. I hope that by singling out this 
particular time-frame, this legislation will focus greater attention on 
improving health care and supportive services during infancy and early 
childhood.
  Second, this bill will require private health insurers to cover 
comprehensive preventive and curative services through age 3. These 
third-party payors will therefore be financially responsible for the 
care children need to be adequately monitored and treated through this 
important developmental period.
  I was startled to learn that 86 percent of children who are privately 
insured are not covered for comprehensive well-child care. Children who 
receive health coverage through the Medicaid Program are covered for a 
comprehensive array of well-child care, diagnostic assessments and 
treatment services through the EPSDT program, yet most children who are 
privately insured do not have similar coverage. Health screenings and 
periodic check-ups provide an important opportunity for physicians to 
ensure that a child's neurological development is progressing along 
normal patterns--and to intervene as appropriate if it is not.
  This comprehensive approach will also address other problems in 
pediatric health care, such as ensuring that children are completely 
covered for immunizations through this time period. This coverage will 
counter current immunization trends that leave 60 percent of children 
in most States with incomplete immunizations at age 2.
  I should also emphasize that this bill, by its very nature, cannot 
help children who are uninsured. We need to pursue further legislation 
that addresses this important problem. In a recent study on children's 
health insurance, the GAO noted that the proportion of children who are 
uninsured--14.2 percent, or 10 million children--is at the highest 
level since 1987. This decline in children's health insurance coverage 
has been concentrated among low-income children.
  Mr. President, all children should have health insurance that covers 
their complete developmental needs. We are the wealthiest, most 
powerful, and most advanced Nation on this planet. But it is 
discouraging that we still have so far to go when it comes to caring 
for our own children.
  My friend and respected colleague Senator John Kerry has offered one 
approach to this problem using sliding-scale subsidies; we should 
explore this option and others in order to ensure that America's 
infants and young children achieve their highest potential. My proposal 
represents the first step toward this important goal--the next step is 
health coverage for all children.
  Mr. President, I ask that the text of S. 2167 be printed in the 
Record.
  The bill follows:

                                S. 2167

       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 ``Children's Health Insurance 
     for Long-Term Development Act of 1996''.

     SEC. 2. PURPOSE.

       The purpose of this act is to provide health insurance 
     coverage for children during the Infant Neurological Risk 
     Exposure Period (INREP). The INREP extends through age 3 and 
     encompasses the period of most rapid neurological changes in 
     young children. Health coverage will improve children's 
     health, and, through routine health supervision, promote 
     parents' caregiving skills through these critical years.

     SEC. 3 FINDINGS.

       Congress finds that--
       (1) 86 percent of children with private health insurance 
     are under-insured with respect to well-child care;
       (2) because the human brain develops rapidly until the age 
     of 3, children need regular screenings and follow-up care to 
     detect neurological abnormalities and ensure normal 
     development;
       (3) regular pediatric visits enable physicians to provide 
     guidance on parental activities, such as reading, that 
     stimulate the brain development of infants; and
       (4) children deserve health care coverage that promotes 
     normal brain and nervous system development.

     SEC. 4. DEFINITIONS.

       As used in this Act:
       (1) Beneficiary.--The term ``beneficiary'' has the meaning 
     given such term under section 3(8) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1002(8)).
       (2) Child.--The term ``child'' means an individual who is 
     age 3 or younger.
       (3) Employee health benefit plan.--
       (A) In general.--The term ``employee health benefit plan'' 
     means any employee welfare benefit plan, governmental plan, 
     or church plan (as defined under paragraphs (1), (32), and 
     (33) of section 3 of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1002 (1), (32), and (33))) 
     that provides or pays for health benefits (such as 
     provider and hospital benefits) for participants and 
     beneficiaries whether--
       (i) directly;
       (ii) through a health plan offered by a health plan issuer 
     as defined in paragraph (6); or
       (iii) otherwise.
       (B) Rule of construction.--An employee health benefit plan 
     shall not be construed to be a health plan or a health plan 
     issuer.
       (C) Arrangements not included.--Such term does not include 
     the following, or any combination thereof:
       (i) Coverage only for accident, or disability income 
     insurance, or any combination thereof.
       (ii) Medicare supplemental health insurance (as defined 
     under section 1882(g)(1) of the Social Security Act (42 
     U.S.C. 1395ss(g)(1))).
       (iii) Coverage issued as a supplement to liability 
     insurance.
       (iv) Liability insurance, including general liability 
     insurance and automobile liability insurance.
       (v) Workers' compensation or similar insurance.
       (vi) Automobile medical payment insurance.
       (vii) Coverage for a specified disease or illness.
       (viii) Hospital or fixed indemnity insurance.
       (ix) Short-term limited duration insurance.
       (x) Credit-only, dental-only, or vision-only insurance.
       (xi) A health insurance policy providing benefits only for 
     long-term care, nursing home care, home health care, 
     community-based care, or any combination thereof.
       (4) Group purchaser.--The term ``group purchaser'' means 
     any person (as defined in section 3(9) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1002(9))) 
     or entity that purchases or pays for health benefits (such as 
     provider or hospital benefits) on behalf of participants or 
     beneficiaries in connection with an employee health benefit 
     plan.
       (5) Health plan.--

[[Page S12468]]

       (A) In general.--The term ``health plan'' means any group 
     health plan or individual health plan.
       (B) Group health plan.--The term ``group health plan'' 
     means any contract, policy, certificate, or other arrangement 
     offered by a health plan issuer to a group purchaser that 
     provides or pays for health benefits (such as provider and 
     hospital benefits) in connection with an employee health 
     benefit plan.
       (C) Individual health plan.--The term ``individual health 
     plan'' means any contract, policy, certificate, or other 
     arrangement offered by a health plan issuer to individuals 
     that provides or pays for health benefits (such as provider 
     and hospital benefits) and that is not a group health plan.
       (D) Arrangements not included.--Such term does not include 
     the following, or any combination thereof:
       (i) Coverage only for accident, or disability income 
     insurance, or any combination thereof.
       (ii) Medicare supplemental health insurance (as defined 
     under section 1882(g)(1) of the Social Security Act).
       (iii) Coverage issued as a supplement to liability 
     insurance.
       (iv) Liability insurance, including general liability 
     insurance and automobile liability insurance.
       (v) Workers' compensation or similar insurance.
       (vi) Automobile medical payment insurance.
       (vii) Coverage for a specified disease or illness.
       (viii) Hospital or fixed indemnity insurance.
       (ix) Short-term limited duration insurance.
       (x) Credit-only, dental-only, or vision-only insurance.
       (xi) A health insurance policy providing benefits only for 
     long-term care, nursing home care, home health care, 
     community-based care, or any combination thereof.
       (E) Certain plans included.--Such term includes any plan or 
     arrangement not described in any clause of subparagraph (D) 
     that provides for benefit payments, on a periodic basis, 
     for--
       (i) a specified disease or illness; or
       (ii) a period of hospitalization;
     without regard to the costs incurred or services rendered 
     during the period to which the payments relate.
       (6) Health plan issuer.--The term ``health plan issuer'' 
     means any entity that is licensed (prior to or after the date 
     of enactment of this Act) by a State to offer a health plan.
       (7) Participant.--The term ``participant'' has the meaning 
     given such term under section 3(7) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1002(7)).
       (8) Secretary.--The term ``Secretary'' unless otherwise 
     specified means the Secretary of Labor.

     SEC. 5. REQUIRED HEALTH CARE COVERAGE FOR CHILDREN.

       (a) In General.--Except as provided in subsection (b), a 
     health plan or an employee health benefit plan shall ensure 
     that coverage is provided with respect to a child who is a 
     beneficiary under such plan for all medically necessary 
     health care and related services, including--
       (1) appropriate screening services at intervals that meet 
     reasonable standards of medical and dental practice;
       (2) all appropriate immunizations;
       (3) necessary case management, transportation, and 
     scheduling assistance; and
       (4) such other necessary health care, diagnostic services, 
     treatment, and other measures to correct or ameliorate 
     defects and physical and mental illnesses and conditions 
     discovered by the screening services, whether or not such 
     services are covered for participants or policyholders under 
     the plan.
       (b) Exception.--Notwithstanding subsection (a), a health 
     plan or an employee health benefit plan shall not be required 
     to provide coverage for health care and related services that 
     are not safe, are not effective, or are experimental.

     SEC. 6. PROHIBITIONS.

       In implementing the requirements of this Act, a health plan 
     or an employee health benefit plan may not use a service 
     limitation, including a lifetime benefit limit, of the plan 
     to deny medically necessary health care and related services 
     described in section 4 to a child.

     SEC. 7. NOTICE.

       (a) Employee Health Benefit Plan.--An employee health 
     benefit plan shall provide conspicuous notice to each 
     participant regarding coverage required under this Act not 
     later than 120 days after the date of enactment of this Act, 
     and as part of its summary plan description.
       (b) Health Plan.--A health plan shall provide notice to 
     each policyholder regarding coverage required under this Act. 
     Such notice shall be in writing, prominently positioned, and 
     be transmitted--
       (1) in a mailing made within 120 days after the date of 
     enactment of this Act by such plan to the policyholder; and
       (2) as part of the annual informational packet sent to the 
     policyholder.

     SEC. 8. APPLICABILITY.

       (a) Construction.--
       (1) In general.--A requirement or standard imposed under 
     this Act on a health plan shall be deemed to be a requirement 
     or standard imposed on the health plan issuer. Such 
     requirements or standards shall be enforced by the State 
     insurance commissioner for the State involved or the official 
     or officials designated by the State to enforce the 
     requirements of this Act. In the case of a health plan 
     offered by a health plan issuer in connection with an 
     employee health benefit plan, the requirements or standards 
     imposed under this Act shall be enforced with respect to the 
     health plan issuer by the State insurance commissioner for 
     the State involved or the official or officials designated by 
     the State to enforce the requirements of this Act.
       (2) Limitation.--Except as provided in section 8(c), the 
     Secretary shall not enforce the requirements or standards of 
     this Act as they relate to health plan issuers or health 
     plans. In no case shall a State enforce the requirements or 
     standards of this Act as they relate to employee health 
     benefit plans.
       (b) Rule of Construction.--Nothing in this Act shall be 
     construed to affect or modify the provisions of section 514 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1144).

     SEC. 9. ENFORCEMENT.

       (a) Health Plan Issuers.--Each State shall require that 
     each health plan issued, sold, renewed, offered for sale or 
     operated in such State by a health plan issuer meet the 
     standards established under this Act. A State shall submit 
     such information as required by the Secretary demonstrating 
     effective implementation of the requirements of this Act.
       (b) Employee Health Benefit Plans.--With respect to 
     employee health benefit plans, the standards established 
     under this Act shall be enforced in the same manner as 
     provided for under sections 502, 504, 506, and 510 of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1132, 1134, 1136, and 1140). The civil penalties contained in 
     paragraphs (1) and (2) of section 502(c) of such Act (29 
     U.S.C. 1132(c) (1) and (2)) shall apply to any information 
     required by the Secretary to be disclosed and reported under 
     this section.
       (c) Failure To Enforce.--In the case of the failure of a 
     State to substantially enforce the standards and requirements 
     set forth in this Act with respect to health plans, the 
     Secretary, in consultation with the Secretary of Health and 
     Human Services, shall enforce the standards of this Act in 
     such State. In the case of a State that fails to 
     substantially enforce the standards set forth in this Act, 
     each health plan issuer operating in such State shall be 
     subject to civil enforcement as provided for under sections 
     502, 504, 506, and 510 of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1132, 1134, 1136, and 1140). 
     The civil penalties contained in paragraphs (1) and (2) of 
     section 502(c) of such Act (29 U.S.C. 1132(c) (1) and (2)) 
     shall apply to any information required by the Secretary to 
     be disclosed and reported under this section.
       (d) Regulations.--The Secretary, in consultation with the 
     Secretary of Health and Human Services, may promulgate such 
     regulations as may be necessary or appropriate to carry out 
     this Act.

     SEC. 10. PREEMPTION.

       (a) In General.--The provisions of sections 4, 5, and 6 
     shall not preempt a State law or regulation--
       (1) that provides greater protections to patients or 
     policyholders than those required in this Act; or
       (2) that requires health plans to provide coverage for 
     pediatric care in accordance with guidelines established by 
     the American Academy of Pediatrics or other established 
     professional medical associations.
       (b) Employee Health Benefit Plans.--Nothing in this section 
     affects the application of this Act to employee health 
     benefit plans, as defined in section 2(3).

     SEC. 11. EFFECTIVE DATE.

       Except as otherwise provided for in this Act, the 
     provisions of this Act shall apply as follows:
       (1) With respect to health plans, such provisions shall 
     apply to such plans on the first day of the contract year 
     beginning on or after June 1, 1997.
       (2) With respect to employee health benefit plans, such 
     provisions shall apply to such plans on the first day of the 
     first plan year beginning on or after June 1, 1997.

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