[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.
____________________