[Congressional Record Volume 147, Number 162 (Wednesday, November 28, 2001)]
[Senate]
[Page S12109]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. McCain, Mr. Daschle, Mr. 
        Baucus, Mrs. Clinton, Mr. Domenici, Mr. Feingold, Mr. Kennedy, 
        Mr. Johnson, Mrs. Murray, Ms. Stabenow, Mr. Wellstone, Mr. 
        Harkin, Mr. Miller, Ms. Snowe, Mr. Inouye, Mr. Smith of Oregon, 
        Ms. Cantwell, Mr. Inhofe, Ms. Landrieu, Mr. Cochran, Mrs. 
        Boxer, Mr. Murkowski, Ms. Mikulski, and Mr. Grassley):
  S. 1741. A bill to amend title XIX of the Social Security Act to 
clarify that Indian women with breast or cervical cancer who are 
eligible for health services provided under a medical care program of 
the Indian Health Service or of a tribal organization are included in 
the optional Medicaid eligibility category of breast or cervical cancer 
patients added by the Breast and Cervical Prevention and Treatment Act 
of 2000; considered and passed.
  Mr. BINGAMAN. Madam President, due to a jurisdiction concern raised 
with the committee referral of S. 535, I am reintroducing the Native 
American Breast and Cervical Cancer Treatment Technical Amendment Act 
of 2001 today with Senator McCain and 23 other bipartisan cosponsors.
  To ensure the availability of life-saving breast and cervical cancer 
treatment to American Indian and Alaska Native women, I urge the bill's 
immediate passage.
  I request unanimous consent that a fact sheet and the text of the 
bill be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1741

       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 ``Native American Breast and 
     Cervical Cancer Treatment Technical Amendment Act of 2001''.

     SEC. 2. CLARIFICATION OF INCLUSION OF INDIAN WOMEN WITH 
                   BREAST OR CERVICAL CANCER IN OPTIONAL MEDICAID 
                   ELIGIBILITY CATEGORY.

       (a) Technical Amendment.--The subsection (aa) of section 
     1902 of the Social Security Act (42 U.S.C. 1396a) added by 
     section 2(a)(2) of the Breast and Cervical Cancer Prevention 
     and Treatment Act of 2000 (Public Law 106-354; 114 Stat. 
     1381) is amended in paragraph (4) by inserting ``, but 
     applied without regard to paragraph (1)(F) of such section'' 
     before the period at the end.
       (b) BIPA Technical Amendments.--
       (1) Section 1902 of the Social Security Act (42 U.S.C. 
     1396a), as amended by section 702(b) of the Medicare, 
     Medicaid, and SCHIP Benefits Improvement and Protection Act 
     of 2000 (114 Stat. 2763A-572) (as enacted into law by section 
     1(a)(6) of Public Law 106-554), is amended by redesignating 
     the subsection (aa) added by such section as subsection (bb).
       (2) Section 1902(a)(15) of the Social Security Act (42 
     U.S.C. 1396a(a)(15)), as added by section 702(a)(2) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (114 Stat. 2763A-572) (as so enacted 
     into law), is amended by striking ``subsection (aa)'' and 
     inserting ``subsection (bb)''.
       (3) Section 1915(b) of the Social Security Act (42 U.S.C. 
     1396n(b)), as amended by section 702(c)(2) of the Medicare, 
     Medicaid, and SCHIP Benefits Improvement and Protection Act 
     of 2000 (114 Stat. 2763A-574) (as so enacted into law), is 
     amended by striking ``1902(aa)'' and inserting ``1902(bb)''.
       (c) Effective Dates.--
       (1) Bccpta technical amendment.--The amendment made by 
     subsection (a) shall take effect as if included in the 
     enactment of the Breast and Cervical Cancer Prevention and 
     Treatment Act of 2000 (Public Law 106-354; 114 Stat. 1381).
       (2) Bipa technical amendments.--The amendments made by 
     subsection (b) shall take effect as if included in the 
     enactment of section 702 of the Medicare, Medicaid, and SCHIP 
     Benefits Improvement and Protection Act of 2000 (114 Stat. 
     2763A-572) (as enacted into law by section 1(a)(6) of Public 
     Law 106-554).
                                  ____


   Fact Sheet--Native American Breast and Cervical Cancer Treatment 
                    Technical Amendment Act of 2001

       Sens. Jeff Bingaman (D-NM), John McCain (R-AZ), and 23 
     additional bipartisan cosponsors are reintroducing the 
     ``Native American Breast and Cervical Cancer Treatment 
     Technical Amendment Act of 2001.'' The bill is identical to 
     the original bill, S. 535, and makes a simple but extremely 
     important technical change to the ``Breast and Cervical 
     Cancer Treatment and Prevention Act'' (P.L. 106-354) to 
     ensure the coverage of breast and cervical cancer treatment 
     for American Indian and Alaska Native women.


                          Need for Legislation

       The ``Breast and Cervical Cancer Treatment and Prevention 
     Act,'' which passed the Senate by unanimous consent and had 
     76 cosponsors, gives states the option to extend coverage to 
     certain women who have been screened by programs operated 
     under Title XV of the Public Health Service Act (the National 
     Breast and Cervical Cancer Early Detection program) and who 
     have no ``creditable coverage.'' The term ``creditable 
     coverage'' was established by the Health Insurance 
     Portability and Accountability Act of 1996 (HIPPA). Under the 
     HIPPA definition, creditable coverage includes a reference to 
     the medical care program of the Indian Health Service (IHS). 
     In short, the reference to ``creditable coverage'' in the law 
     effectively excludes Indian women from receiving Medicaid 
     breast and cervical cancer treatment as provided for under 
     this Act.
       The Indian health reference to IHS/tribal care was 
     originally included in HIPPA so that members of Indian Tribes 
     eligible for IHS would not be treated as having a break in 
     coverage (and thus subject to pre-existing exclusions and 
     waiting periods when seeking health insurance) simply because 
     they had received care through Indian health programs, rather 
     than through a conventional health insurance program. Thus, 
     in the HIPPA context, the inclusion of the IHS/tribal 
     provision was intended to benefit American Indians and Alaska 
     Natives, not penalize them.
       However, use of the HIPPA definition in the recent ``Breast 
     and Cervical Cancer Treatment and Prevention Act'' has the 
     exact opposite effect. In fact, the many Indian women, who 
     rely on IHS/tribal programs for basic health care, are 
     excluded from the new law's eligibility for Medicaid. Not 
     only does the definition deny coverage to Indian women, but 
     the provision runs counter to the general Medicaid rule 
     treating IHS facilities as full Medicaid providers.
       The legislation would resolve these problems by clarifying 
     that, for purposes of the ``Breast and Cervical Cancer 
     Prevention and Treatment Act,'' the term ``creditable 
     coverage'' shall not include IHS-funded care so that American 
     Indian and Alaska Native women can be covered by Medicaid for 
     breast and cervical cancer treatment. Since a number of 
     states are currently moving forward to provide Medicaid 
     coverage under the state option, the need for this 
     legislation is immediate to ensure that American Indian and 
     Alaska Native women are not denied from receiving life-saving 
     breast and cervical cancer treatment.


     

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