[Congressional Record Volume 147, Number 177 (Wednesday, December 19, 2001)]
[House]
[Pages H10904-H10906]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    NATIVE AMERICAN BREAST AND CERVICAL CANCER TREATMENT TECHNICAL 
                         AMENDMENT ACT OF 2001

  Mr. GILLMOR. Mr. Speaker, I move to suspend the rules and pass the 
Senate bill (S. 1741) 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 Cancer Prevention and 
Treatment Act of 2000.
  The Clerk read 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).

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Ohio (Mr. Gillmor) and the gentleman from New Jersey (Mr. Pallone) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Ohio (Mr. Gillmor).


                             general leave

  Mr. GILLMOR. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative day within

[[Page H10905]]

which to revise and extend their remarks and include extraneous 
material on this legislation.
  The SPEAKER pro tempore. Is their objection to the request of the 
gentleman from Ohio?
  There was no objection.
  Mr. GILLMOR. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of S. 1741, the Native American Breast 
and Cervical Cancer Treatment Technical Amendment Act of 2001.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am also in support of the legislation. While this bill 
is technical in nature, it does basically fill a vacuum and it offers 
real benefits to low income Native American women who are diagnosed 
with breast or cervical cancer.
  Basically what happened is that in a bill that was passed last year, 
the interpretation of it has been made so that it excludes Native 
American women have Medicaid coverage. The legislation today would 
resolve this problem by clarifying that they would indeed come under 
the coverage of that initial legislation.
  I would point out that Native American and Alaskan Native women have 
a higher incidence of breast and cervical cancer than the U.S. 
population generally. So it really is important that we enact this bill 
to ensure that they receive needed assistance.
  The Senate already passed the legislation by unanimous consent. It is 
supported by a number of health care groups. And I just again want to 
extend my appreciation and recognition to the lead sponsor, the 
gentleman from New Mexico (Mr. Tom Udall) and also commend the 
gentlewoman from California (Ms. Eshoo) who worked tirelessly on this.
  Mr. Speaker, I yield back the balance of my time.
  Mr. GILLMOR. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I just want to point out I do want to express my 
appreciation to the tremendous work that our staff did on the previous 
legislation we passed.
  Mr. PALLONE. Mr. Speaker, I am pleased to speak today in support of 
S. 1741, the ``Native American Breast and Cervical Cancer Treatment 
Technical Amendment Act of 2001.'' This legislation makes a simple but 
extremely important technical change to the ``Breast and Cervical 
Cancer Treatment and Prevention Act'' to improve the coverage of breast 
and cervical cancer treatment for American Indian and Alaska Native 
women.
  The Breast and Cervical Cancer Treatment Act--which Congress passed 
last year--gives States the option to extend coverage to certain women 
who have been screened by programs operated under the National Breast 
and Cervical Cancer Early Detection program of the Public Health 
Service Act and who have no ``creditable coverage.'' The term 
``creditable coverage'' was established by the Health Insurance 
Portability and Accountability Act of 1996 (HIPAA). Under the HIPAA 
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 HIPAA so that members of Indian tribes eligible for IHS 
would not be treated as having a break in coverage simply because they 
had received care through Indian health programs, rather than through a 
conventional health insurance program. Thus, in the HIPAA context, the 
inclusion of the IHS/tribal provision was intended to benefit American 
Indians and Alaska Natives, not penalize them.
  However, use of the HIPAA 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.
  While American Indian and Alaska Native women have a higher incidence 
of breast and cervical cancer than the U.S. population generally, many 
Indian women with these conditions will be left with fewer resources to 
fight breast and cervical cancer because of their exclusion from the 
new Medicaid coverage option.
  This bill, S. 1741, 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.
  Up to 40 States have either taken the option and have been granted a 
Medicaid state plan amendment by HHS already or are in the process of 
filing a Medicaid state plan amendment to provide coverage to low-
income for breast and cervical cancer treatment as a result of the 
passage of last year's bill. Unfortunately, in all of those states, 
Native American women may be ineligible for coverage unless we take up 
this technical correction. Time is of the essence to pass this 
legislation so that Native American women are appropriately provided 
treatment for their breast and cervical cancer as States begin 
implementing this law.
  I am pleased today, that we are taking action on this bill. When the 
time comes for a vote, I urge all of my colleagues to support it and I 
hope that we may pass this bill before the end of the year.
  Mr. WATTS of Oklahoma. Mister Speaker, it is a fact that American 
Indian and Alaska Native women have a higher incidence of breast and 
cervical cancer than the general population of the United States.
  Unfortunately, many of these women who are at a higher risk of breast 
and cervical cancer are also without the life-saving care they need. 
This is due to the fact that American Indian and Alaska Native women 
are eligible for breast cancer diagnosis coverage, but not medical 
treatment.
  American Indian and Alaska Native women need the option for more 
advanced care. The legislation before the House today would improve the 
coverage of breast and cervical cancer treatment for these Americans by 
putting them on equal footing with other low-income citizens eligible 
for Medicaid.
  Mister Speaker, breast and cervical cancer can be the worst 
nightmares thinkable for women. Thankfully, this Congress has made 
health care and medical research a top priority--promoting increased 
health care benefits, empowering patients to get the best care possible 
and generously funding disease research.
  By correcting the system to allow American Indian and Alaska Native 
women the treatment they need with respect to breast and cervical 
cancer, we will aid these who need help the most. I thank my colleagues 
for their work on this important issue and urge passage of the 
legislation.
  Mr. HAYWORTH. Mr. Speaker, I rise today to express my support for the 
Native American Breast and Cervical Cancer Treatment Technical 
Amendment Act.
  I am a cosponsor of this important legislation that would make a 
simple but extremely technical change to the ``Breast Cancer and 
Cervical Treatment and Prevention Act'' (P.L. 106-354). The legislation 
would improve the coverage of breast and cervical cancer treatment for 
American Indian and Alaska Native women.
  The Breast and Cervical Cancer Treatment Act, which Congress passed 
last year, 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 (HIPAA). Under the HIPAA 
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 
Native American women from receiving Medicaid breast and cervical 
cancer treatment as provided for under this act.
  The Native American health reference to IHS/tribal care was 
originally included in HIPAA 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 HIPAA context, the inclusion of the IHS/tribal 
provision was intended to benefit American Indians and Alaska Natives, 
not penalize them.
  However, use of the HIPAA 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 form the new law's eligibility for 
Medicaid.

[[Page H10906]]

  Not only does the definition deny coverage to Indian women, but the 
provision also runs counter to the general Medicaid rule treating IHS 
facilities as full Medicaid providers.
  This 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 of this legislation 
is immediate to ensure that American Indian and Alaska Native women are 
not denied life-saving breast and cervical cancer treatment.
  I urge my colleagues to vote yes on the Native American Breast and 
Cervical Cancer Treatment Technical Amendment Act that is critically 
important to many American Indian and Native Alaskan Women.
  Mr. DINGELL. Mr. Speaker, I rise today in support of the Native 
American Breast and Cervical Cancer Treatment Technical Amendment Act 
of 2001. While this bill is technical in nature, it offers real 
benefits to low-income Native American women who are diagnosed with 
breast or cervical cancer.
  The bill makes a technical correction to legislation that Congress 
enacted last year, the Breast and Cervical Cancer Treatment and 
Prevention Act. Last year's legislation allowed States, at their 
option, to cover low-income women diagnosed with breast or cervical 
cancer through the Centers for Disease Control and Prevention screening 
program under Medicaid. The bill, however, inadvertently excluded 
Native American women from receiving assistance under this option due 
to an underlying definition of ``creditable coverage'' intended to 
protect Native Americans receiving health services through Indian 
Health Services in the context of the Health Insurance Portability and 
Accountability Act. Unfortunately, in this instance, the definition had 
the effect of excluding Native American women from coverage rather than 
protecting them. The legislation before us today will resolve this 
problem by clarifying the term ``creditable coverage.''
  While Native American and Alaskan Native women have a higher 
incidence of breast and cervical cancer than the U.S. population 
generally, the exclusion from the new Medicaid coverage option leaves 
Native American women with fewer resources to fight their breast and 
cervical cancer. This legislation needs quick enactment to ensure that 
Native American and Alaskan Native women receive this needed 
assistance.
  The Senate already passed this legislation by unanimous consent. This 
bill is supported by the American College of Obstetricians and 
Gynecologists and American Cancer Society among others. I am pleased 
that the House will address this very important issue this year.
  I wish to extend my appreciation and recognition as well to my 
colleagues on both sides of the aisle who have worked on this issue, 
including the lead sponsor Representative Tom Udall. I also want to 
commend Representative Anna Eshoo, who worked tirelessly last year to 
make this State option under Medicaid a reality. I urge my colleagues 
to join me in supporting this bill.
  Mr. GILLMOR. Mr. Speaker, I yield back the balance of my time.

                              {time}  0500

  The SPEAKER pro tempore (Mr. Shimkus). The question is on the motion 
offered by the gentleman from Ohio (Mr. Gillmor) that the House suspend 
the rules and pass the Senate bill, S. 1741.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the Senate bill was passed.
  A motion to reconsider was laid on the table.

                          ____________________