[Congressional Record Volume 149, Number 39 (Tuesday, March 11, 2003)]
[Senate]
[Pages S3551-S3556]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 258. Mrs. MURRAY (for herself, Mr. Reid, and Mrs. Boxer) proposed 
an amendment to the bill S. 3, to prohibit the procedures commonly 
known as partial-birth abortion; as follows:

       Beginning on page 18, strike line 23 and all that follows 
     through the end of the bill and insert the following:

            TITLE __--PROVISIONS RELATING TO CONTRACEPTIVES

     Subtitle A--Equitable Coverage of Prescription Contraceptives

     SEC. __01. SHORT TITLE.

       This subtitle may be cited as the ``Equity in Prescription 
     Insurance and Contraceptive Coverage Act of 2003''.

     SEC. __02. FINDINGS.

       Congress finds that--
       (1) each year, 3,000,000 pregnancies, or one half of all 
     pregnancies, in this country are unintended;
       (2) contraceptive services are part of basic health care, 
     allowing families to both adequately space desired 
     pregnancies and avoid unintended pregnancy;
       (3) studies show that contraceptives are cost effective: 
     for every $1 of public funds invested in family planning, $4 
     to $14 of public funds is saved in pregnancy and health care-
     related costs;
       (4) by reducing rates of unintended pregnancy, 
     contraceptives help reduce the need for abortion;
       (5) unintended pregnancies lead to higher rates of infant 
     mortality, low-birth weight, and maternal morbidity, and 
     threaten the economic viability of families;
       (6) the National Commission to Prevent Infant Mortality 
     determined that ``infant mortality could be reduced by 10 
     percent if all women not desiring pregnancy used 
     contraception'';
       (7) most women in the United States, including three-
     quarters of women of childbearing age, rely on some form of 
     private insurance (through their own employer, a family 
     member's employer, or the individual market) to defray their 
     medical expenses;
       (8) the vast majority of private insurers cover 
     prescription drugs, but many exclude coverage for 
     prescription contraceptives;
       (9) private insurance provides extremely limited coverage 
     of contraceptives: half of traditional indemnity plans and 
     preferred provider organizations, 20 percent of point-of-
     service networks, and 7 percent of health maintenance 
     organizations cover no contraceptive methods other than 
     sterilization;
       (10) women of reproductive age spend 68 percent more than 
     men on out-of-pocket health care costs, with contraceptives 
     and reproductive health care services accounting for much of 
     the difference;
       (11) the lack of contraceptive coverage in health insurance 
     places many effective forms of contraceptives beyond the 
     financial reach of many women, leading to unintended 
     pregnancies;
       (12) the Institute of Medicine Committee on Unintended 
     Pregnancy recommended that

[[Page S3552]]

     ``financial barriers to contraception be reduced by 
     increasing the proportion of all health insurance policies 
     that cover contraceptive services and supplies'';
       (13) in 1998, Congress agreed to provide contraceptive 
     coverage to the 2,000,000 women of reproductive age who are 
     participating in the Federal Employees Health Benefits 
     Program, the largest employer-sponsored health insurance plan 
     in the world; and
       (14) eight in 10 privately insured adults support 
     contraceptive coverage.

     SEC. __03. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME 
                   SECURITY ACT OF 1974.

       (a) In General.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 714. STANDARDS RELATING TO BENEFITS FOR 
                   CONTRACEPTIVES.

       ``(a) Requirements for Coverage.--A group health plan, and 
     a health insurance issuer providing health insurance coverage 
     in connection with a group health plan, may not--
       ``(1) exclude or restrict benefits for prescription 
     contraceptive drugs or devices approved by the Food and Drug 
     Administration, or generic equivalents approved as 
     substitutable by the Food and Drug Administration, if such 
     plan provides benefits for other outpatient prescription 
     drugs or devices; or
       ``(2) exclude or restrict benefits for outpatient 
     contraceptive services if such plan provides benefits for 
     other outpatient services provided by a health care 
     professional (referred to in this section as `outpatient 
     health care services').
       ``(b) Prohibitions.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, may not--
       ``(1) deny to an individual eligibility, or continued 
     eligibility, to enroll or to renew coverage under the terms 
     of the plan because of the individual's or enrollee's use or 
     potential use of items or services that are covered in 
     accordance with the requirements of this section;
       ``(2) provide monetary payments or rebates to a covered 
     individual to encourage such individual to accept less than 
     the minimum protections available under this section;
       ``(3) penalize or otherwise reduce or limit the 
     reimbursement of a health care professional because such 
     professional prescribed contraceptive drugs or devices, or 
     provided contraceptive services, described in subsection (a), 
     in accordance with this section; or
       ``(4) provide incentives (monetary or otherwise) to a 
     health care professional to induce such professional to 
     withhold from a covered individual contraceptive drugs or 
     devices, or contraceptive services, described in subsection 
     (a).
       ``(c) Rules of Construction.--
       ``(1) In general.--Nothing in this section shall be 
     construed--
       ``(A) as preventing a group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan from imposing 
     deductibles, coinsurance, or other cost-sharing or 
     limitations in relation to--
       ``(i) benefits for contraceptive drugs under the plan, 
     except that such a deductible, coinsurance, or other cost-
     sharing or limitation for any such drug may not be greater 
     than such a deductible, coinsurance, or cost-sharing or 
     limitation for any outpatient prescription drug otherwise 
     covered under the plan;
       ``(ii) benefits for contraceptive devices under the plan, 
     except that such a deductible, coinsurance, or other cost-
     sharing or limitation for any such device may not be greater 
     than such a deductible, coinsurance, or cost-sharing or 
     limitation for any outpatient prescription device otherwise 
     covered under the plan; and
       ``(iii) benefits for outpatient contraceptive services 
     under the plan, except that such a deductible, coinsurance, 
     or other cost-sharing or limitation for any such service may 
     not be greater than such a deductible, coinsurance, or cost-
     sharing or limitation for any outpatient health care service 
     otherwise covered under the plan; and
       ``(B) as requiring a group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan to cover experimental or 
     investigational contraceptive drugs or devices, or 
     experimental or investigational contraceptive services, 
     described in subsection (a), except to the extent that the 
     plan or issuer provides coverage for other experimental or 
     investigational outpatient prescription drugs or devices, or 
     experimental or investigational outpatient health care 
     services.
       ``(2) Limitations.--As used in paragraph (1), the term 
     `limitation' includes--
       ``(A) in the case of a contraceptive drug or device, 
     restricting the type of health care professionals that may 
     prescribe such drugs or devices, utilization review 
     provisions, and limits on the volume of prescription drugs or 
     devices that may be obtained on the basis of a single 
     consultation with a professional; or
       ``(B) in the case of an outpatient contraceptive service, 
     restricting the type of health care professionals that may 
     provide such services, utilization review provisions, 
     requirements relating to second opinions prior to the 
     coverage of such services, and requirements relating to 
     preauthorizations prior to the coverage of such services.
       ``(d) Notice Under Group Health Plan.--The imposition of 
     the requirements of this section shall be treated as a 
     material modification in the terms of the plan described in 
     section 102(a)(1), for purposes of assuring notice of such 
     requirements under the plan, except that the summary 
     description required to be provided under the last sentence 
     of section 104(b)(1) with respect to such modification shall 
     be provided by not later than 60 days after the first day of 
     the first plan year in which such requirements apply.
       ``(e) Preemption.--Nothing in this section shall be 
     construed to preempt any provision of State law to the extent 
     that such State law establishes, implements, or continues in 
     effect any standard or requirement that provides protections 
     for enrollees that are greater than the protections provided 
     under this section.
       ``(f) Definition.--In this section, the term `outpatient 
     contraceptive services' means consultations, examinations, 
     procedures, and medical services, provided on an outpatient 
     basis and related to the use of contraceptive methods 
     (including natural family planning) to prevent an unintended 
     pregnancy.''.
       (b) Clerical Amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1001) is amended by inserting after the item relating 
     to section 713 the following:

``Sec. 714. Standards relating to benefits for contraceptives.''.

       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2004.

     SEC. __04. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT 
                   RELATING TO THE GROUP MARKET.

       (a) In General.--Subpart 2 of part A of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR 
                   CONTRACEPTIVES.

       ``(a) Requirements for Coverage.--A group health plan, and 
     a health insurance issuer providing health insurance coverage 
     in connection with a group health plan, may not--
       ``(1) exclude or restrict benefits for prescription 
     contraceptive drugs or devices approved by the Food and Drug 
     Administration, or generic equivalents approved as 
     substitutable by the Food and Drug Administration, if such 
     plan provides benefits for other outpatient prescription 
     drugs or devices; or
       ``(2) exclude or restrict benefits for outpatient 
     contraceptive services if such plan provides benefits for 
     other outpatient services provided by a health care 
     professional (referred to in this section as `outpatient 
     health care services').
       ``(b) Prohibitions.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, may not--
       ``(1) deny to an individual eligibility, or continued 
     eligibility, to enroll or to renew coverage under the terms 
     of the plan because of the individual's or enrollee's use or 
     potential use of items or services that are covered in 
     accordance with the requirements of this section;
       ``(2) provide monetary payments or rebates to a covered 
     individual to encourage such individual to accept less than 
     the minimum protections available under this section;
       ``(3) penalize or otherwise reduce or limit the 
     reimbursement of a health care professional because such 
     professional prescribed contraceptive drugs or devices, or 
     provided contraceptive services, described in subsection (a), 
     in accordance with this section; or
       ``(4) provide incentives (monetary or otherwise) to a 
     health care professional to induce such professional to 
     withhold from covered individual contraceptive drugs or 
     devices, or contraceptive services, described in subsection 
     (a).
       ``(c) Rules of Construction.--
       ``(1) In general.--Nothing in this section shall be 
     construed--
       ``(A) as preventing a group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan from imposing 
     deductibles, coinsurance, or other cost-sharing or 
     limitations in relation to--
       ``(i) benefits for contraceptive drugs under the plan, 
     except that such a deductible, coinsurance, or other cost-
     sharing or limitation for any such drug may not be greater 
     than such a deductible, coinsurance, or cost-sharing or 
     limitation for any outpatient prescription drug otherwise 
     covered under the plan;
       ``(ii) benefits for contraceptive devices under the plan, 
     except that such a deductible, coinsurance, or other cost-
     sharing or limitation for any such device may not be greater 
     than such a deductible, coinsurance, or cost-sharing or 
     limitation for any outpatient prescription device otherwise 
     covered under the plan; and
       ``(iii) benefits for outpatient contraceptive services 
     under the plan, except that such a deductible, coinsurance, 
     or other cost-sharing or limitation for any such service may 
     not be greater than such a deductible, coinsurance, or cost-
     sharing or limitation for any outpatient health care service 
     otherwise covered under the plan; and
       ``(B) as requiring a group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan to cover experimental or 
     investigational contraceptive drugs or devices, or 
     experimental or investigational contraceptive services, 
     described in subsection (a), except to the extent that the 
     plan or issuer

[[Page S3553]]

     provides coverage for other experimental or investigational 
     outpatient prescription drugs or devices, or experimental or 
     investigational outpatient health care services.
       ``(2) Limitations.--As used in paragraph (1), the term 
     `limitation' includes--
       ``(A) in the case of a contraceptive drug or device, 
     restricting the type of health care professionals that may 
     prescribe such drugs or devices, utilization review 
     provisions, and limits on the volume of prescription drugs or 
     devices that may be obtained on the basis of a single 
     consultation with a professional; or
       ``(B) in the case of an outpatient contraceptive service, 
     restricting the type of health care professionals that may 
     provide such services, utilization review provisions, 
     requirements relating to second opinions prior to the 
     coverage of such services, and requirements relating to 
     preauthorizations prior to the coverage of such services.
       ``(d) Notice.--A group health plan under this part shall 
     comply with the notice requirement under section 714(d) of 
     the Employee Retirement Income Security Act of 1974 with 
     respect to the requirements of this section as if such 
     section applied to such plan.
       ``(e) Preemption.--Nothing in this section shall be 
     construed to preempt any provision of State law to the extent 
     that such State law establishes, implements, or continues in 
     effect any standard or requirement that provides protections 
     for enrollees that are greater than the protections provided 
     under this section.
       ``(f) Definition.--In this section, the term `outpatient 
     contraceptive services' means consultations, examinations, 
     procedures, and medical services, provided on an outpatient 
     basis and related to the use of contraceptive methods 
     (including natural family planning) to prevent an unintended 
     pregnancy.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply with respect to group health plans for plan years 
     beginning on or after January 1, 2004.

     SEC. __05. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT 
                   RELATING TO THE INDIVIDUAL MARKET.

       (a) In General.--Part B of title XXVII of the Public Health 
     Service Act (42 U.S.C. 300gg-41 et seq.) is amended--
       (1) by redesignating the first subpart 3 (relating to other 
     requirements) as subpart 2; and
       (2) by adding at the end of subpart 2 the following:

     ``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR 
                   CONTRACEPTIVES.

       ``The provisions of section 2707 shall apply to health 
     insurance coverage offered by a health insurance issuer in 
     the individual market in the same manner as they apply to 
     health insurance coverage offered by a health insurance 
     issuer in connection with a group health plan in the small or 
     large group market.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply with respect to health insurance coverage 
     offered, sold, issued, renewed, in effect, or operated in the 
     individual market on or after January 1, 2004.

                  Subtitle B--Emergency Contraception

     SEC. __11. SHORT TITLE.

       This subtitle may be cited as the ``Emergency Contraception 
     Education Act''.

     SEC. __12. FINDINGS.

       Congress finds that--
       (1) each year, 3,000,000 pregnancies, or one half of all 
     pregnancies, in the United States are unintended, and half of 
     all of these unintended pregnancies end in abortion;
       (2) the Food and Drug Administration has declared emergency 
     contraception to be safe and effective in preventing 
     unintended pregnancy, reducing the risk by as much as 89 
     percent;
       (3) the most commonly used forms of emergency contraception 
     are regimens of ordinary birth control pills taken within 72 
     hours of unprotected intercourse or contraceptive failure;
       (4) emergency contraception, also known as post-coital 
     contraception, is a responsible means of preventing pregnancy 
     that works like other hormonal contraception to delay 
     ovulation, prevent fertilization or prevent implantation;
       (5) emergency contraception does not cause abortion and 
     will not affect an established pregnancy;
       (6) it is estimated that the use of emergency contraception 
     could cut the number of unintended pregnancies in half, 
     thereby reducing the need for abortion;
       (7) emergency contraceptive use is the United States 
     remains low, and 9 in 10 women of reproductive age remain 
     unaware of the method;
       (8) although the American College of Obstetricians and 
     Gynecologists recommends that doctors routinely offer women 
     of reproductive age a prescription for emergency 
     contraceptive pills during their annual visit, only 1 in 5 
     ob/gyns routinely discuss emergency contraception with their 
     patients, suggesting the need for greater provider and 
     patient education;
       (9) in light of their safety and efficacy, both the 
     American Medical Association and the American College of 
     Obstetricians and Gynecologists have endorsed more widespread 
     availability of emergency contraceptive pills, and have 
     recommended that dedicated emergency contraceptive products 
     be available without a prescription;
       (10) Healthy People 2010, published by the Office of the 
     Surgeon General, establishes a 10-year national public health 
     goal of increasing the proportion of health care providers 
     who provide emergency contraception to their patients; and
       (11) public awareness campaigns targeting women and health 
     care providers will help remove many of the barriers to 
     emergency contraception and will help bring this important 
     means of pregnancy prevention to American women.

     SEC. __13. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION 
                   PROGRAMS.

       (a) Definitions.--In this section:
       (1) Emergency contraception.--The term ``emergency 
     contraception'' means a drug or device (as the terms are 
     defined in section 201 of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 321)) that is--
       (A) used after sexual relations; and
       (B) prevents pregnancy, by preventing ovulation, 
     fertilization of an egg, or implantation of an egg in a 
     uterus.
       (2) Health care provider.--The term ``health care 
     provider'' means an individual who is licensed or certified 
     under State law to provide health care services and who is 
     operating within the scope of such license.
       (3) Institution of higher education.--The term 
     ``institution of higher education'' has the same meaning 
     given such term in section 1201(a) of the Higher Education 
     Act of 1965 (20 U.S.C. 1141(a)).
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (b) Emergency Contraception Public Education Program.--
       (1) In general.--The Secretary, acting through the Director 
     of the Centers for Disease Control and Prevention, shall 
     develop and disseminate to the public information on 
     emergency contraception.
       (2) Dissemination.--The Secretary may disseminate 
     information under paragraph (1) directly or through 
     arrangements with nonprofit organizations, consumer groups, 
     institutions of higher education, Federal, State, or local 
     agencies, clinics and the media.
       (3) Information.--The information disseminated under 
     paragraph (1) shall include, at a minimum, a description of 
     emergency contraception, and an explanation of the use, 
     safety, efficacy, and availability of such contraception.
       (c) Emergency Contraception Information Program for Health 
     Care Providers.--
       (1) In general.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration and in consultation with major medical and 
     public health organizations, shall develop and disseminate to 
     health care providers information on emergency contraception.
       (2) Information.--The information disseminated under 
     paragraph (1) shall include, at a minimum--
       (A) information describing the use, safety, efficacy and 
     availability of emergency contraception;
       (B) a recommendation regarding the use of such 
     contraception in appropriate cases; and
       (C) information explaining how to obtain copies of the 
     information developed under subsection (b), for distribution 
     to the patients of the providers.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     each of fiscal years 2004 through 2008.

   Subtitle C--Compassionate Care for Female Sexual Assault Survivors

     SEC. __21. SHORT TITLE.

       This subtitle may be cited as the ``Compassionate Care for 
     Female Sexual Assault Survivors Act''.

     SEC. __22. FINDINGS.

       Congress finds that--
       (1) it is estimated that 25,000 women become pregnant each 
     year as a result of rape or incest;
       (2) surveys have shown that many hospitals do not routinely 
     provide emergency contraception to women seeking treatment 
     after being sexually assaulted;
       (3) the risk of pregnancy after sexual assault has been 
     estimated to be 4.7 percent in survivors who were not 
     protected by some form of contraception at the time of the 
     attack;
       (4) the Food and Drug Administration has declared emergency 
     contraception to be safe and effective in preventing 
     unintended pregnancy, reducing the risk by as much as 89 
     percent;
       (5) medical research strongly indicates that the sooner 
     emergency contraception is administered, the greater the 
     likelihood of preventing unintended pregnancy, and it is most 
     effective if administered in the first 12 hours after 
     unprotected intercourse;
       (6) in light of the safety and effectiveness of emergency 
     contraceptive pills, both the American Medical Association 
     and the American College of Obstetricians and Gynecologists 
     have endorsed more widespread availability of such pills; and
       (7) it is essential that all hospitals that provide 
     emergency medical treatment provide emergency contraception 
     as a treatment option to any woman who has been sexually 
     assaulted, so she may prevent an unintended pregnancy.

     SEC. __23. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY 
                   HOSPITALS OF EMERGENCY CONTRACEPTIVES WITHOUT 
                   CHARGE.

       (a) In General.--Federal funds may not be provided to a 
     hospital under any health-related program unless the hospital 
     meets the conditions specified in subsection (b) in the

[[Page S3554]]

     case of any woman who presents at the hospital and--
       (1) states that she is the victim of sexual assault;
       (2) is accompanied by someone who states she is a victim of 
     sexual assault; or
       (3) whom hospital personnel have reason to believe is a 
     victim of sexual assault.
       (b) Assistance for Victims.--The conditions specified in 
     this subsection regarding a hospital and a woman described in 
     subsection (a) are as follows:
       (1) The hospital promptly provides the woman with medically 
     and factually accurate and unbiased written and oral 
     information about emergency contraception, including 
     information explaining that--
       (A) emergency contraception does not cause an abortion; and
       (B) emergency contraception is effective in most cases in 
     preventing pregnancy after unprotected sex.
       (2) The hospital promptly offers emergency contraception to 
     the woman, and promptly provides it to her upon her request.
       (3) The information provided pursuant to paragraph (1) is 
     in clear and concise language, is readily comprehensible, and 
     meets such conditions regarding the provision of the 
     information in languages other than English as the Secretary 
     may establish.
       (4) The services described in paragraphs (1) through (3) 
     are not denied because of the inability of the woman or her 
     family to pay for the services.
       (c) Definitions.--In this section:
       (1) Emergency contraception.--The term ``emergency 
     contraception'' means a drug that is--
       (A) used postcoitally;
       (B) prevents pregnancy by delaying ovulation, preventing 
     fertilization of an egg, or preventing implantation of an egg 
     in a uterus; and
       (C) is approved by the Food and Drug Administration.
       (2) Hospital.--The term ``hospital'' has the meanings given 
     such term in title XVIII of the Social Security Act, 
     including the meaning applicable in such title for purposes 
     of making payments for emergency services to hospitals that 
     do not have agreements in effect under such title.
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (4) Sexual assault.--The term ``sexual assault'' means 
     coitus in which the woman involved does not consent or lacks 
     the legal capacity to consent.
       (d) Effective Date; Agency Criteria.--This section takes 
     effect upon the expiration of the 180-day period beginning on 
     the date of the enactment of this Act. Not later than 30 days 
     prior to the expiration of such period, the Secretary shall 
     publish in the Federal Register criteria for carrying out 
     this section.

   Subtitle D--Improved Coverage of Infants Under Medicaid and SCHIP

     SEC. __31. ENHANCED FEDERAL MEDICAID MATCH FOR STATES THAT 
                   OPT TO CONTINUOUSLY ENROLL INFANTS DURING THE 
                   FIRST YEAR OF LIFE WITHOUT REGARD TO THE 
                   MOTHER'S ELIGIBILITY STATUS.

       (a) State Option.--Section 1902(e)(4) of the Social 
     Security Act (42 U.S.C. 1396a(e)(4)) is amended by adding at 
     the end the following new sentence: ``A State may elect 
     (through a State plan amendment) to apply the first sentence 
     of this paragraph without regard to the requirements that the 
     child remain a member of the woman's household and the woman 
     remains (or would remain if pregnant) eligible for medical 
     assistance.''.
       (b) Enhanced FMAP.--The first sentence of section 1905(b) 
     of the Social Security Act (42 U.S.C. 1396d(b)) is amended--
       (1) by inserting ``(A)'' after ``only''; and
       (2) by inserting ``, or (B) on the basis of a State 
     election made under the third sentence of section 
     1902(e)(4)'' before the period.
       (c) Effective Date.--The amendments made by this section 
     apply to medical assistance provided on or after October 1, 
     2003.

     SEC. __32. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED 
                   PREGNANT WOMEN UNDER A STATE CHILD HEALTH PLAN.

       (a) In General.--Title XXI of the Social Security Act (42 
     U.S.C. 1397aa et seq.) is amended by adding at the end the 
     following new section:

     ``SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED 
                   PREGNANT WOMEN.

       ``(a) Optional Coverage.--Notwithstanding any other 
     provision of this title, a State child health plan (whether 
     implemented under this title or title XIX) may provide for 
     coverage of pregnancy-related assistance for targeted low-
     income pregnant women in accordance with this section, but 
     only if the State has established an income eligibility level 
     under section 1902(l)(2)(A) for women described in section 
     1902(l)(1)(A) that is 185 percent of the income official 
     poverty line.
       ``(b) Definitions.--For purposes of this section:
       ``(1) Pregnancy-related assistance.--The term `pregnancy-
     related assistance' has the meaning given the term child 
     health assistance in section 2110(a) as if any reference to 
     targeted low-income children were a reference to targeted 
     low-income pregnant women, except that the assistance shall 
     be limited to services related to pregnancy (which include 
     prenatal, delivery, and postpartum services) and to other 
     conditions that may complicate pregnancy.
       ``(2) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' has the meaning given 
     the term targeted low-income child in section 2110(b) as if 
     any reference to a child were deemed a reference to a woman 
     during pregnancy and through the end of the month in which 
     the 60-day period (beginning on the last day of her 
     pregnancy) ends.
       ``(c) References to Terms and Special Rules.--In the case 
     of, and with respect to, a State providing for coverage of 
     pregnancy-related assistance to targeted low-income pregnant 
     women under subsection (a), the following special rules 
     apply:
       ``(1) Any reference in this title (other than subsection 
     (b)) to a targeted low income child is deemed to include a 
     reference to a targeted low-income pregnant woman.
       ``(2) Any such reference to child health assistance with 
     respect to such women is deemed a reference to pregnancy-
     related assistance.
       ``(3) Any such reference to a child is deemed a reference 
     to a woman during pregnancy and the period described in 
     subsection (b)(2).
       ``(4) The medicaid applicable income level is deemed a 
     reference to the income level established under section 
     1902(l)(2)(A).
       ``(5) Subsection (a) of section 2103 (relating to required 
     scope of health insurance coverage) shall not apply insofar 
     as a State limits coverage to services described in 
     subsection (b)(1) and the reference to such section in 
     section 2105(a)(1) is deemed not to require, in such case, 
     compliance with the requirements of section 2103(a).
       ``(6) There shall be no exclusion of benefits for services 
     described in subsection (b)(1) based on any pre-existing 
     condition and no waiting period (including any waiting period 
     imposed to carry out section 2102(b)(3)(C)) shall apply.
       ``(d) No Impact on Allotments.--Nothing in this section 
     shall be construed as affecting the amount of any initial 
     allotment provided to a State under section 2104(b).
       ``(e) Application of Funding Restrictions.--The coverage 
     under this section (and the funding of such coverage) is 
     subject to the restrictions of section 2105(c).
       ``(f) Automatic Enrollment for Children Born to Women 
     Receiving Pregnancy-Related Assistance.--Notwithstanding any 
     other provision of this title or title XIX, if a child is 
     born to a targeted low-income pregnant woman who was 
     receiving pregnancy-related assistance under this section on 
     the date of the children's birth, the child shall be deemed 
     to have applied for child health assistance under the State 
     child health plan and to have been found eligible for such 
     assistance under such plan (or, in the case of a State that 
     provides such assistance through the provision of medical 
     assistance under a plan under title XIX, to have applied for 
     medical assistance under such title and to have been found 
     eligible for such assistance under such title) on the date of 
     such birth and to remain eligible for such assistance until 
     the child attains 1 year of age. During the period in which a 
     child is deemed under the preceding sentence to be eligible 
     for child health or medical assistance, the child health or 
     medical assistance eligibility identification number of the 
     mother shall also serve as the identification number of the 
     child, and all claims shall be submitted and paid under such 
     number (unless the State issues a separate identification 
     number for the child before such period expires).''.
       (b) State Option To Use Enhanced FMAP and SCHIP Allotment 
     for Coverage of Additional Pregnant Women Under the Medicaid 
     Program.--Section 1905 of the Social Security Act (42 U.S.C. 
     1396d) is amended--
       (1) in the fourth sentence of subsection (b), by inserting 
     ``and in the case of a State plan that meets the condition 
     described in subsections (u)(1) and (u)(4)(A), with respect 
     to expenditures described in subsection (u)(4)(B) for the 
     State for a fiscal year'' after ``for a fiscal year,''; and
       (2) in subsection (u)--
       (A) by redesignating paragraph (4) as paragraph (5); and
       (B) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4)(A) The condition described in this subparagraph for a 
     State plan is that the plan has established an income level 
     under section 1902(l)(2)(A) with respect to individuals 
     described in section 1902(l)(1)(A) that is 185 percent of the 
     income official poverty line.
       ``(B) For purposes of subsection (b), the expenditures 
     described in this paragraph are expenditures for medical 
     assistance for women described in section 1902(l)(1)(A) whose 
     income exceeds the income level established for such women 
     under section 1902(l)(2)(A)(i) as of the date of the 
     enactment of this paragraph but does not exceed 185 percent 
     of the income official poverty line.''.
       (c) No Waiting Periods or Cost-Sharing.--
       (1) No waiting period.--Section 2102(b)(1)(B) of the Social 
     Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
       (A) by striking ``, and'' at the end of clause (i) and 
     inserting a semicolon;
       (B) by striking the period at the end of clause (ii) and 
     inserting ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iii) may not apply a waiting period (including a waiting 
     period to carry out paragraph (3)(C)) in the case of a 
     targeted low-income pregnant woman, if the State provides for 
     coverage of pregnancy-related assistance for such women in 
     accordance with section 2111.''.

[[Page S3555]]

       (2) No cost-sharing for pregnancy-related benefits.--
     Section 2103(e)(2) of such Act (42 U.S.C. 1397cc(e)(2)) is 
     amended--
       (A) in the heading, by inserting ``and pregnancy-related 
     services'' after ``preventive services''; and
       (B) by inserting before the period at the end the 
     following: ``or for pregnancy-related services, if the State 
     provides for coverage of pregnancy-related assistance for 
     targeted low-income pregnant women in accordance section 
     2111''.
       (d) Presumptive Eligibility.--
       (1) In general.--Section 1920A(b)(3)(A)(i)(III) of the 
     Social Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)(III)) is 
     amended by inserting ``a child care resource and referral 
     agency,'' after ``a State or tribal child support enforcement 
     agency,''.
       (2) Application to presumptive eligibility for pregnant 
     women under medicaid.--Section 1920(b) of the Social Security 
     Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end 
     after and below paragraph (2) the following flush sentence:

     ``The term `qualified provider' includes a qualified entity 
     as defined in section 1920A(b)(3).''.
       (3) Application under title xxi.--
       (A) In general.--Section 2107(e)(1)(D) of the Social 
     Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as 
     follows:
       ``(D) Sections 1920 and 1920A (relating to presumptive 
     eligibility).''.
       (B) Exception from limitation on administrative expenses.--
     Section 2105(c)(2) of the Social Security Act (42 U.S.C. 
     1397ee(c)(2)) is amended by adding at the end the following 
     new subparagraph:
       ``(C) Exception for presumptive eligibility expenditures.--
     The limitation under subparagraph (A) on expenditures shall 
     not apply to expenditures attributable to the application of 
     section 1920 or 1920A (pursuant to section 2107(e)(1)(D)), 
     regardless of whether the child or pregnant woman is 
     determined to be ineligible for the program under this title 
     or title XIX.''.
       (e) Program Coordination With the Maternal and Child Health 
     Program (Title V).--
       (1) In general.--Section 2102(b)(3) of the Social Security 
     Act (42 U.S.C. 1397bb(b)(3)) is amended--
       (A) in subparagraph (D), by striking ``and'' at the end;
       (B) in subparagraph (E), by striking the period and 
     inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(F) that operations and activities under this title are 
     developed and implemented in consultation and coordination 
     with the program operated by the State under title V in areas 
     including outreach and enrollment, benefits and services, 
     service delivery standards, public health and social service 
     agency relationships, and quality assurance and data 
     reporting.''.
       (2) Conforming medicaid amendment.--Section 1902(a)(11) of 
     such Act (42 U.S.C. 1396a(a)(11)) is amended--
       (A) by striking ``and'' before ``(C)''; and
       (B) by inserting before the semicolon at the end the 
     following: ``, and (D) provide that operations and activities 
     under this title are developed and implemented in 
     consultation and coordination with the program operated by 
     the State under title V in areas including outreach and 
     enrollment, benefits and services, service delivery 
     standards, public health and social service agency 
     relationships, and quality assurance and data reporting''.
       (3) Effective date.--The amendments made by this subsection 
     take effect on January 1, 2004.
       (f) Application of Annual Aggregate Cost-Sharing Limit.--
     Section 2103(e)(3)(B) of the Social Security Act (42 U.S.C. 
     1397cc(e)(3)(B)) is amended by adding at the end the 
     following new sentence: ``In the case of a targeted low-
     income pregnant woman provided coverage under section 2111, 
     or the parents of a targeted low-income child provided 
     coverage under this title under an 1115 waiver or otherwise, 
     the limitation on total annual aggregate cost-sharing 
     described in the preceding sentence shall be applied to the 
     entire family of such woman or parents.''.
       (g) Effective Date.--Except as provided in subsection (e), 
     the amendments made by this section take effect on the date 
     of the enactment of this Act and apply to expenditures 
     incurred on or after that date.

     SEC. __33. INCREASE IN SCHIP INCOME ELIGIBILITY.

       (a) Definition of Low-Income Child.--Section 2110(c)(4) of 
     the Social Security Act (42 U.S.C. 42 U.S.C. 1397jj(c)(4)) is 
     amended by striking ``200'' and inserting ``250''.
       (b) Effective Date.--The amendment made by subsection (a) 
     applies to child health assistance provided, and allotments 
     determined under section 2104 of the Social Security Act (42 
     U.S.C. 1397dd), for fiscal years beginning with fiscal year 
     2004.
                                 ______
                                 
  SA 259. Mr. DURBIN (for himself, Ms. Collins, Ms. Snowe, Mr. Akaka, 
Mr. Bingaman, Ms. Landrieu, and Ms. Mikulski) proposed an amendment to 
the bill S. 3, to prohibit the procedure commonly known as partial-
birth abortion; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Late Term Abortion 
     Limitation Act of 2003''.

     SEC. 2. BAN ON CERTAIN ABORTIONS.

       (a) In General.--Title 18, United States Code, is amended 
     by inserting after chapter 73 the following:

                 ``CHAPTER 74--BAN ON CERTAIN ABORTIONS

``Sec.
``1531. Prohibition of post-viability abortions.
``1532. Penalties.
``1533. Regulations.
``1534. State law.
``1535. Definitions.

     ``Sec. 1531. Prohibition of Post-Viability Abortions.

       ``(a) In General.--It shall be unlawful for a physician to 
     intentionally abort a viable fetus unless the physician prior 
     to performing the abortion including the procedure 
     characterized as a ``partial birth abortion''--
       ``(1) certifies in writing that, in the physician's medical 
     judgment based on the particular facts of the case before the 
     physician, the continuation of the pregnancy would threaten 
     the mother's life or risk grievous injury to her physical 
     health; and
       ``(2) an independent physician who will not perform nor be 
     present at the abortion and who was not previously involved 
     in the treatment of the mother certifies in writing that, in 
     his or her medical judgment based on the particular facts of 
     the case, the continuation of the pregnancy would threaten 
     the mother's life or risk grievous injury to her physical 
     health.
       ``(b) No Conspiracy.--No woman who has had an abortion 
     after fetal viability may be prosecuted under this chapter 
     for conspiring to violate this chapter or for an offense 
     under section 2, 3, 4, or 1512 of title 18.
       ``(c) Medical Emergency Exception.--The certification 
     requirements contained in subsection (a) shall not apply 
     when, in the medical judgment of the physician performing the 
     abortion based on the particular facts of the case before the 
     physician, there exists a medical emergency. In such a case, 
     however, after the abortion has been completed the physician 
     who performed the abortion shall certify in writing the 
     specific medical condition which formed the basis for 
     determining that a medical emergency existed.

     ``Sec. 1532. Penalties.

       ``(a) Action by the Attorney General.--The Attorney 
     General, the Deputy Attorney General, the Associate Attorney 
     General, or any Assistant Attorney General or United States 
     Attorney specifically designated by the Attorney General may 
     commence a civil action under this chapter in any appropriate 
     United States district court to enforce the provisions of 
     this chapter.
       ``(b) First Offense.--Upon a finding by the court that the 
     respondent in an action commenced under subsection (a) has 
     knowingly violated a provision of this chapter, the court 
     shall notify the appropriate State medical licensing 
     authority in order to effect the suspension of the 
     respondent's medical license in accordance with the 
     regulations and procedures developed by the State under 
     section 1533(b), or shall assess a civil penalty against the 
     respondent in an amount not to exceed $100,000, or both.
       ``(c) Second Offense--Upon a finding by the court that the 
     respondent in an action commenced under subsection (a) has 
     knowingly violated a provision of this chapter and the 
     respondent has been found to have knowingly violated a 
     provision of this chapter on a prior occasion, the court 
     shall notify the appropriate State medical licensing 
     authority in order to effect the revocation of the 
     respondent's medical license in accordance with the 
     regulations and procedures developed by the State under 
     section 1533(b), or shall assess a civil penalty against the 
     respondent in an amount not to exceed $250,000, or both.
       ``(d) Hearing.--With respect to an action under subsection 
     (a), the appropriate State medical licensing authority shall 
     be given notification of and an opportunity to be heard at a 
     hearing to determine the penalty to be imposed under this 
     section.
       ``(e) Certification Requirements.--At the time of the 
     commencement of an action under subsection (a), the Attorney 
     General, the Deputy Attorney General, the Associate Attorney 
     General, or any Assistant Attorney General or United States 
     Attorney who has been specifically designated by the Attorney 
     General to commence a civil action under this chapter, shall 
     certify to the court involved that, at least 30 calendar days 
     prior to the filing of such action, the Attorney General, the 
     Deputy Attorney General, the Associate Attorney General, or 
     any Assistant Attorney General or United States Attorney 
     involved--
       ``(1) has provided notice of the alleged violation of this 
     chapter, in writing, to the Governor or Chief Executive 
     Officer and Attorney General or Chief Legal Officer of the 
     State or political subdivision involved, as well as to the 
     State medical licensing board or other appropriate State 
     agency; and
       ``(2) believes that such an action by the United States is 
     in the public interest and necessary to secure substantial 
     justice.

     ``Sec. 1533. Regulations.

       ``(a) Federal Regulations.--
       ``(1) In general.--Not later than 60 days after the date of 
     enactment of this chapter, the Secretary of Health and Human 
     Services shall publish proposed regulations for the filing of 
     certifications by physicians under this chapter.

[[Page S3556]]

       ``(2) Requirements.--The regulations under paragraph (1) 
     shall require that a certification filed under this chapter 
     contain--
       ``(A) a certification by the physician performing the 
     abortion, under threat of criminal prosecution under section 
     1746 of title 28 that, in his or her best medical judgment, 
     the abortion performed was medically necessary pursuant to 
     this chapter;
       ``(B) a description by the physician of the medical 
     indications supporting his or her judgment;
       ``(C) a certification by an independent physician pursuant 
     to section 1531(a)(2), under threat of criminal prosecution 
     under section 1746 of title 28, that, in his or her best 
     medical judgment, the abortion performed was medically 
     necessary pursuant to this chapter; and
       ``(D) a certification by the physician performing an 
     abortion under a medical emergency pursuant to section 
     1531(c), under threat of criminal prosecution under section 
     1746 of title 28, that, in his or her best medical judgment, 
     a medical emergency existed, and the specific medical 
     condition upon which the physician based his or her decision.
       ``(3) Confidentiality.--The Secretary of Health and Human 
     Services shall promulgate regulations to ensure that the 
     identity of a mother described in section 1531(a)(1) is kept 
     confidential, with respect to a certification filed by a 
     physician under this chapter.
       ``(b) State Regulations.--A State, and the medical 
     licensing authority of the State, shall develop regulations 
     and procedures for the revocation or suspension of the 
     medical license of a physician upon a finding under section 
     1532 that the physician has violated a provision of this 
     chapter. A State that fails to implement such procedures 
     shall be subject to loss of funding under title XIX of the 
     Social Security Act.

     ``Sec. 1534. State Law.

       ``(a) In General.--The requirements of this chapter shall 
     not apply with respect to post-viability abortions in a State 
     if there is a State law in effect in that State that 
     regulates, restricts, or prohibits such abortions to the 
     extent permitted by the Constitution of the United States.
       ``(b) Definition.--In subsection (a), the term `State law' 
     means all laws, decisions, rules, or regulations of any 
     State, or any other State action, having the effect of law.

     ``Sec. 1535. Definitions.

       ``In this chapter:
       ``(1) Grievous injury.--
       ``(A) In general.--The term `grievous injury' means--
       ``(i) a severely debilitating disease or impairment 
     specifically caused or exacerbated by the pregnancy; or
       ``(ii) an inability to provide necessary treatment for a 
     life-threatening condition.
       ``(B) Limitation.--The term `grievous injury' does not 
     include any condition that is not medically diagnosable or 
     any condition for which termination of the pregnancy is not 
     medically indicated.
       ``(2) Physician.--The term `physician' means a doctor of 
     medicine or osteopathy legally authorized to practice 
     medicine and surgery by the State in which the doctor 
     performs such activity, or any other individual legally 
     authorized by the State to perform abortions, except that any 
     individual who is not a physician or not otherwise legally 
     authorized by the State to perform abortions, but who 
     nevertheless directly performs an abortion in violation of 
     section 1531 shall be subject to the provisions of this 
     chapter.''.
       (b) Clerical Amendment.--The table of chapters for part I 
     of title 18, United States Code, is amended by inserting 
     after the item relating to chapter 73 the following new item:

1531.''.on certain abortions.........................................

                          ____________________