[Congressional Record Volume 149, Number 144 (Wednesday, October 15, 2003)]
[Senate]
[Pages S12612-S12616]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. LINCOLN (for herself, Mr. Lugar, and Mr. Bingaman):
  S. 1734. A bill to amend titles XIX and XXI of the Social Security 
Act to provide States with the option to expand or add coverage of 
pregnant women under the medicaid and State children's health insurance 
programs, and for other purposes; to the Committee on Finance.
   Mrs. LINCOLN. Mr. President, I am pleased to introduce the Prevent 
Prematurity and Improve Child Health Act of 2003, which seeks to reduce 
the incidence of prematurity and improve the health of women of 
childbearing age and children. I am joined in this effort today by my 
colleagues Senators Richard Lugar and Jeff Bingaman.
   The number of premature births is increasing at an alarming rate. 
According to data from the National Center for Health Statistics, more 
than 476,000 infants were born prematurely in 2001--a 27 percent 
increase since 1981 and the highest level ever reported in the United 
States. Prematurity, which is defined as birth at less than 37 
completed weeks of gestation, is the leading cause of infant death in 
the first month of life. Today, one in eight infants is born too early. 
Unfortunately, in my own State of Arkansas, the problem of preterm 
births is even more astounding. In 2001, more than 13 percent of births 
were preterm, ranking Arkansas 43rd in the Nation. This is a clear 
wake-up call: we must take action to reduce the number of premature 
births, improving the health of hundreds of thousands of infants born 
each year. Not to mention the cost savings that will result from 
bringing healthy babies into the world.
  This legislation I introduced today gives States increased 
flexibility and the Federal resources needed to improve access to 
prenatal care for low-income pregnant women. Specifically, it will give 
States new options to cover pregnant women under the State Children's 
Health Insurance Program (SCHIP) and to cover low-income legal 
immigrant pregnant women and children under Medicaid and SCHIP. At 
least one in eight pregnant women are uninsured, according to a 1999 
study conducted by Emory University professor Ken Thorpe for the March 
of Dimes. Uninsured women receive fewer prenatal services and report 
greater difficulty in obtaining needed care than women with insurance, 
an Institute of Medicine study concluded. The National Center for 
Health Statistics reports that infants born to mothers who received 
late or no prenatal care in 2000 were about twice as likely to be low 
birthweight, less than 5\1/2\ pounds, as infants born to mothers who 
received early prenatal care--9.9 percent compared with 5.5 percent. 
Timing of entry into prenatal care often reflects factors also 
associated with low birthweight, including maternal age and poverty. 
Increased access to prenatal care will give women greater access to 
screening and diagnostic tests as well as education, counseling, and 
referral services to reduce risky behaviors like substance abuse and 
poor nutrition. Such care may thus help improve the health of both 
mothers and their infants.
   Premature birth can happen to any family. In fact, nearly half of 
premature births have no known cause. but we do know that a whole host 
of factors are associated with increased risk, including maternal age, 
multiple births, a history of preterm delivery, stress, infection, 
smoking and drug use.
  Additionally, this bill tackles a major prematurity risk factor--
maternal smoking--by improving and expanding coverage for 
pharmaceuticals and counseling that will help income-eligible pregnant 
women enrolled in the program quit smoking. Almost 20 percent of 
pregnant women ages 15 to 44 smoke, according to the Centers for 
Disease Control and Prevention. But pregnancy is a powerful motivator 
to help women stop smoking. Women who smoke are more likely to stop 
during pregnancy, both spontaneously and with assistance, than at any 
other time. According to the Surgeon General, programs to help pregnant 
women quit smoking can increase cessation rates, benefiting infant 
health, and are cost-effective. Yet many States' Medicaid programs do 
not reimburse counseling services aimed at helping pregnant smokers 
understand the medical consequences their smoking can have on their 
unborn child and giving them the tools they need to quit. For some 
pregnant women, counseling is not enough and a physician may prescribe 
pharmaceuticals. At least 35 States already include at least one type 
of smoking cessation pharmaceutical in their Medicaid programs. This 
bill will require all States to include these drugs that, when 
prescribed by a physician, can help pregnant women stop smoking.
  The bill also contains a provision directing the Administrator of the 
Health Resources and Services Administration (HRSA) to review the core 
performance measures in the Maternal and Child Health block grant and 
determine if there are sufficient prematurity-related measures, 
including the percentage of infants born to mothers that smoke while 
pregnant.
  This bill also gives States the tools they need to help low-income 
women enrolled in Medicaid avoid another risk factor for premature 
birth--spacing pregnancies too close together. In recent years, a 
number of States, including Arkansas, have sought and received Federal 
permission in the form of waivers to provide Medicaid-financed family 
planning services and supplies to income-eligible uninsured residents 
whose incomes are above the state's regular Medicaid eligibility 
ceilings. This bill would make it possible for States to extend 
Medicaid coverage for family planning services without having to obtain 
a federal waiver.
  Finally, the bill will improve the health care of some infants and 
children with disabilities, such as those born prematurely, who have 
private health insurance with limited benefits that do not meet their 
health needs. Currently, infants and children must be uninsured to be 
eligible for SCHIP. However, this provision will give states the 
ability to use federal funds available under SCHIP to include income-
eligible underinsured infants and children in SCHIP, as is currently 
permitted in Medicaid. This secondary payer provision will allow 
children to continue to be enrolled in their family's private health 
policy, and at the same time obtain the full spectrum of health 
services they need.
  I encourage my colleagues to join us as supporters of this important 
legislation to give states the tools they need to reduce the rate of 
premature births and improve the health care of pregnant women, infants 
and children across the nation.
  Mr. President, I ask unanimous consent that the full text of the 
Prevent Prematurity and Improve Child Health Act be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1734

       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 ``Prevent Prematurity and 
     Improve Child Health Act of 2003''.

     SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN 
                   PREGNANT WOMEN UNDER MEDICAID AND SCHIP.

       (a) Medicaid.--
       (1) Authority to expand coverage.--Section 1902(l)(2)(A)(i) 
     of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)(i)) is 
     amended by inserting ``(or such higher percentage as the 
     State may elect for purposes of expenditures for medical 
     assistance for pregnant women described in section 
     1905(u)(4)(A))'' after ``185 percent''.
       (2) Enhanced matching funds available if certain conditions 
     met.--Section 1905 of the Social Security Act (42 U.S.C. 
     1396d) is amended--
       (A) in the fourth sentence of subsection (b), by striking 
     ``or subsection (u)(3)'' and inserting ``, (u)(3), or 
     (u)(4)''; and
       (B) in subsection (u)--
       (i) by redesignating paragraph (4) as paragraph (5); and
       (ii) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) For purposes of the fourth sentence of subsection (b) 
     and section 2105(a), the expenditures described in this 
     paragraph are the following:

[[Page S12613]]

       ``(A) Certain pregnant women.--If the conditions described 
     in subparagraph (B) are met, expenditures for medical 
     assistance for pregnant women described in subsection (n) or 
     under section 1902(l)(1)(A) in a family the income of which 
     exceeds 185 percent of the poverty line, but does not exceed 
     the income eligibility level established under title XXI for 
     a targeted low-income child.
       ``(B) Conditions.--The conditions described in this 
     subparagraph are the following:
       ``(i) The State plans under this title and title XXI do not 
     provide coverage for pregnant women described in subparagraph 
     (A) with higher family income without covering such pregnant 
     women with a lower family income.
       ``(ii) The State does not apply an effective income level 
     for pregnant women that is lower than the effective income 
     level (expressed as a percent of the poverty line and 
     considering applicable income disregards) that has been 
     specified under the State plan under subsection 
     (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902, as of 
     January 1, 2003, to be eligible for medical assistance as a 
     pregnant woman.
       ``(C) Definition of poverty line.--In this subsection, the 
     term `poverty line' has the meaning given such term in 
     section 2110(c)(5).''.
       (3) Payment from title xxi allotment for medicaid expansion 
     costs; elimination of counting medicaid child presumptive 
     eligibility costs against title xxi allotment.--Section 
     2105(a)(1) of the Social Security Act (42 U.S.C. 
     1397ee(a)(1)) is amended--
       (A) in the matter preceding subparagraph (A), by striking 
     ``(or, in the case of expenditures described in subparagraph 
     (B), the Federal medical assistance percentage (as defined in 
     the first sentence of section 1905(b)))''; and
       (B) by striking subparagraph (B) and inserting the 
     following new subparagraph:
       ``(B) for the provision of medical assistance that is 
     attributable to expenditures described in section 
     1905(u)(4)(A);''.
       (b) SCHIP.--
       (1) Coverage.--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 TARGETED LOW-INCOME 
                   PREGNANT WOMEN.

       ``(a) Optional Coverage.--Notwithstanding any other 
     provision of this title, a State may provide for coverage, 
     through an amendment to its State child health plan under 
     section 2102, of pregnancy-related assistance for targeted 
     low-income pregnant women in accordance with this section, 
     but only if--
       ``(1) the State has established an income eligibility level 
     for pregnant women under subsection (a)(10)(A)(i)(III) or 
     (l)(2)(A) of section 1902 that is at least 185 percent of the 
     income official poverty line; and
       ``(2) the State meets the conditions described in section 
     1905(u)(4)(B).
       ``(b) Definitions.--For purposes of this title:
       ``(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 services 
     described in section 1905(a)(4)(C)) and to other conditions 
     that may complicate pregnancy.
       ``(2) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' means a woman--
       ``(A) during pregnancy and through the end of the month in 
     which the 60-day period (beginning on the last day of her 
     pregnancy) ends;
       ``(B) whose family income exceeds the effective income 
     level (expressed as a percent of the poverty line and 
     considering applicable income disregards) that has been 
     specified under subsection (a)(10)(A)(i)(III) or (l)(2)(A) of 
     section 1902, as of January 1, 2003, to be eligible for 
     medical assistance as a pregnant woman under title XIX but 
     does not exceed the income eligibility level established 
     under the State child health plan under this title for a 
     targeted low-income child; and
       ``(C) who satisfies the requirements of paragraphs (1)(A), 
     (1)(C), (2), and (3) of section 2110(b).
       ``(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 in 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)(A).
       ``(4) In applying section 2102(b)(3)(B), any reference to 
     children found through screening to be eligible for medical 
     assistance under the State medicaid plan under title XIX is 
     deemed a reference to pregnant women.
       ``(5) There shall be no exclusion of benefits for services 
     described in subsection (b)(1) based on any preexisting 
     condition and no waiting period (including any waiting period 
     imposed to carry out section 2102(b)(3)(C)) shall apply.
       ``(6) 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)(C) is deemed not to require, in such case, 
     compliance with the requirements of section 2103(a).
       ``(7) In applying section 2103(e)(3)(B) in the case of a 
     pregnant woman provided coverage under this section, the 
     limitation on total annual aggregate cost-sharing shall be 
     applied to such pregnant woman.
       ``(8) The reference in section 2107(e)(1)(D) to section 
     1920A (relating to presumptive eligibility for children) is 
     deemed a reference to section 1920 (relating to presumptive 
     eligibility for pregnant women).
       ``(d) Automatic Enrollment for Children Born to Women 
     Receiving Pregnancy-Related Assistance.--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 child'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 to have applied for medical 
     assistance under title XIX and to have been found eligible 
     for such assistance under such title, as appropriate, 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).''.
       (2) Additional allotments for providing coverage of 
     pregnant women.--
       (A) In general.--Section 2104 of the Social Security Act 
     (42 U.S.C. 1397dd) is amended by inserting after subsection 
     (c) the following new subsection:
       ``(d) Additional Allotments for Providing Coverage of 
     Pregnant Women.--
       ``(1) Appropriation; total allotment.--For the purpose of 
     providing additional allotments to States under this title, 
     there is appropriated, out of any money in the Treasury not 
     otherwise appropriated, for each of fiscal years 2004 through 
     2007, $200,000,000.
       ``(2) State and territorial allotments.--In addition to the 
     allotments provided under subsections (b) and (c), subject to 
     paragraphs (3) and (4), of the amount available for the 
     additional allotments under paragraph (1) for a fiscal year, 
     the Secretary shall allot to each State with a State child 
     health plan approved under this title--
       ``(A) in the case of such a State other than a commonwealth 
     or territory described in subparagraph (B), the same 
     proportion as the proportion of the State's allotment under 
     subsection (b) (determined without regard to subsection (f)) 
     to the total amount of the allotments under subsection (b) 
     for such States eligible for an allotment under this 
     paragraph for such fiscal year; and
       ``(B) in the case of a commonwealth or territory described 
     in subsection (c)(3), the same proportion as the proportion 
     of the commonwealth's or territory's allotment under 
     subsection (c) (determined without regard to subsection (f)) 
     to the total amount of the allotments under subsection (c) 
     for commonwealths and territories eligible for an allotment 
     under this paragraph for such fiscal year.
       ``(3) Use of additional allotment.--Additional allotments 
     provided under this subsection are not available for amounts 
     expended before October 1, 2003. Such amounts are available 
     for amounts expended on or after such date for child health 
     assistance for targeted low-income children, as well as for 
     pregnancy-related assistance for targeted low-income pregnant 
     women.
       ``(4) No payments unless election to expand coverage of 
     pregnant women.--No payments may be made to a State under 
     this title from an allotment provided under this subsection 
     unless the State provides pregnancy-related assistance for 
     targeted low-income pregnant women under this title, or 
     provides medical assistance for pregnant women under title 
     XIX, whose family income exceeds the effective income level 
     applicable under subsection (a)(10)(A)(i)(III) or (l)(2)(A) 
     of section 1902 to a family of the size involved as of 
     January 1, 2003.''.
       (B) Conforming amendments.--Section 2104 of the Social 
     Security Act (42 U.S.C. 1397dd) is amended--
       (i) in subsection (a), in the matter preceding paragraph 
     (1), by inserting ``subject to subsection (d),'' after 
     ``under this section,'';
       (ii) in subsection (b)(1), by inserting ``and subsection 
     (d)'' after ``Subject to paragraph (4)''; and
       (iii) in subsection (c)(1), by inserting ``subject to 
     subsection (d),'' after ``for a fiscal year,''.
       (3) Additional conforming amendments.--
       (A) No cost-sharing for pregnancy-related benefits.--
     Section 2103(e)(2) of the Social Security Act (42 U.S.C. 
     1397cc(e)(2)) is amended--

[[Page S12614]]

       (i) in the heading, by inserting ``or pregnancy-related 
     services'' after ``preventive services''; and
       (ii) by inserting before the period at the end the 
     following: ``or for pregnancy-related services''.
       (B) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C. 
     1397bb(b)(1)(B)) is amended--
       (i) in clause (i), by striking ``, and'' at the end and 
     inserting a semicolon;
       (ii) in clause (ii), by striking the period at the end and 
     inserting ``; and''; and
       (iii) 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.''.
       (c) Authority for States that Provide Medicaid or SCHIP 
     Coverage for Pregnant Women with Income Above 185 Percent of 
     the Poverty Line to Use Portion of SCHIP Funds for Medicaid 
     Expenditures.--Section 2105(g) of the Social Security Act (42 
     U.S.C. 1397ee(g)), as added by section 1(b) of Public Law 
     108-74, is amended--
       (1) in the subsection heading, by inserting ``and Certain 
     Pregnancy Coverage Expansion States'' after ``Qualifying 
     States'';
       (2) by adding at the end the following:
       ``(4) Special authority for certain pregnancy coverage 
     expansion states.--
       ``(A) In general.--In the case of a State that, as of the 
     date of enactment of the Prevent Prematurity and Improve 
     Child Health Act of 2003, has an income eligibility standard 
     under title XIX or this title (under section 1902(a)(10)(A) 
     or under a statewide waiver in effect under section 1115 with 
     respect to title XIX or this title) that is at least 185 
     percent of the poverty line with respect to pregnant women, 
     the State may elect to use not more than 20 percent of any 
     allotment under section 2104 for any fiscal year (insofar as 
     it is available under subsections (e) and (g) of such 
     section) for payments under title XIX in accordance with 
     subparagraph (B), instead of for expenditures under this 
     title.
       ``(B) Payments to states.--
       ``(i) In general.--In the case of a State described in 
     subparagraph (A) that has elected the option described in 
     that subparagraph, subject to the availability of funds under 
     such subparagraph and, if applicable, paragraph (1)(A), with 
     respect to the State, the Secretary shall pay the State an 
     amount each quarter equal to the additional amount that would 
     have been paid to the State under title XIX with respect to 
     expenditures described in clause (ii) if the enhanced FMAP 
     (as determined under subsection (b)) had been substituted for 
     the Federal medical assistance percentage (as defined in 
     section 1905(b)).
       ``(ii) Expenditures described.--For purposes of this 
     subparagraph, the expenditures described in this clause are 
     expenditures, made after the date of the enactment of this 
     paragraph and during the period in which funds are available 
     to the State for use under subparagraph (A), for medical 
     assistance under title XIX for pregnant women whose family 
     income is at least 185 percent of the poverty line.
       ``(iii) No impact on determination of budget neutrality for 
     waivers.--In the case of a State described in subparagraph 
     (A) that uses amounts paid under this paragraph for 
     expenditures described in clause (ii) that are incurred under 
     a waiver approved for the State, any budget neutrality 
     determinations with respect to such waiver shall be 
     determined without regard to such amounts paid.''; and
       (3) in paragraph (3), by striking ``and (2)'' and inserting 
     ``(2), and (4)''.
       (d) Other Amendments to Medicaid.--
       (1) Eligibility of a newborn.--Section 1902(e)(4) of the 
     Social Security Act (42 U.S.C. 1396a(e)(4)) is amended in the 
     first sentence by striking ``so long as the child is a member 
     of the woman's household and the woman remains (or would 
     remain if pregnant) eligible for such assistance''.
       (2) Application of qualified entities 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 after paragraph (2) the following flush 
     sentence:
     ``The term `qualified provider' includes a qualified entity 
     as defined in section 1920A(b)(3).''.
       (e) Effective Date.--The amendments made by this section 
     apply to items and services furnished on or after October 1, 
     2003, without regard to whether regulations implementing such 
     amendments have been promulgated.

     SEC. 3. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE 
                   MEDICAID PROGRAM AND SCHIP.

       (a) Medicaid Program.--Section 1903(v) of the Social 
     Security Act (42 U.S.C. 1396b(v)) is amended--
       (1) in paragraph (1), by striking ``paragraph (2)'' and 
     inserting ``paragraphs (2) and (4)''; and
       (2) by adding at the end the following new paragraph:
       ``(4)(A) A State may elect (in a plan amendment under this 
     title) to provide medical assistance under this title for 
     aliens who are lawfully residing in the United States 
     (including battered aliens described in section 431(c) of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996) and who are otherwise eligible for such 
     assistance, within any of the following eligibility 
     categories:
       ``(i) Pregnant women.--Women during pregnancy (and during 
     the 60-day period beginning on the last day of the 
     pregnancy).
       ``(ii) Children.--Children (as defined under such plan), 
     including optional targeted low-income children described in 
     section 1905(u)(2)(B).
       ``(B)(i) In the case of a State that has elected to provide 
     medical assistance to a category of aliens under subparagraph 
     (A), no debt shall accrue under an affidavit of support 
     against any sponsor of such an alien on the basis of 
     provision of assistance to such category and the cost of such 
     assistance shall not be considered as an unreimbursed cost.
       ``(ii) The provisions of sections 401(a), 402(b), 403, and 
     421 of the Personal Responsibility and Work Opportunity 
     Reconciliation Act of 1996 shall not apply to a State that 
     makes an election under subparagraph (A).''.
       (b) Title XXI.--Section 2107(e)(1) of the Social Security 
     Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end 
     the following new subparagraph:
       ``(E) Section 1903(v)(4) (relating to optional coverage of 
     permanent resident alien pregnant women and children), but 
     only with respect to an eligibility category under this 
     title, if the same eligibility category has been elected 
     under such section for purposes of title XIX.''.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2003, and apply to medical 
     assistance and child health assistance furnished on or after 
     such date.

     SEC. 4. PROMOTING CESSATION OF TOBACCO USE UNDER THE MEDICAID 
                   PROGRAM.

       (a) Dropping Exception From Medicaid Prescription Drug 
     Coverage for Tobacco Cessation Medications.--Section 
     1927(d)(2) of the Social Security Act (42 U.S.C. 1396r-
     8(d)(2)) is amended--
       (1) by striking subparagraph (E);
       (2) by redesignating subparagraphs (F) through (J) as 
     subparagraphs (E) through (I), respectively; and
       (3) in subparagraph (F) (as redesignated by paragraph (2)), 
     by inserting before the period at the end the following: ``, 
     except agents approved by the Food and Drug Administration 
     for purposes of promoting, and when used to promote, tobacco 
     cessation''.
       (b) Requiring Coverage of Tobacco Cessation Counseling 
     Services for Pregnant Women.--Section 1905 of the Social 
     Security Act (42 U.S.C. 1396d(a)(4)) is amended--
       (1) in subsection (a)(4)--
       (A) by striking ``and'' before ``(C)''; and
       (C) by inserting before the semicolon at the end the 
     following new subparagraph: ``; and (D) counseling for 
     cessation of tobacco use (as defined in subsection (x)) for 
     pregnant women''; and
       (2) by adding at the end the following:
       ``(x)(1) For purposes of this title, the term `counseling 
     for cessation of tobacco use' means therapy and counseling 
     for cessation of tobacco use for pregnant women who use 
     tobacco products or who are being treated for tobacco use 
     that is furnished--
       ``(A) by or under the supervision of a physician; or
       ``(B) by any other health care professional who--
       ``(i) is legally authorized to furnish such services under 
     State law (or the State regulatory mechanism provided by 
     State law) of the State in which the services are furnished; 
     and
       ``(ii) is authorized to receive payment for other services 
     under this title or is designated by the Secretary for this 
     purpose.
       ``(2) Subject to paragraph (3), such term is limited to--
       ``(A) therapy and counseling services recommended in 
     `Treating Tobacco Use and Dependence: A Clinical Practice 
     Guideline', published by the Public Health Service in June 
     2000, or any subsequent modification of such Guideline; and
       ``(B) such other therapy and counseling services that the 
     Secretary recognizes to be effective.
       ``(3) Such term shall not include coverage for drugs or 
     biologicals that are not otherwise covered under this 
     title.''.
       (c) Removal of Cost-Sharing for Tobacco Cessation 
     Counseling Services for Pregnant Women.--Section 1916 of the 
     Social Security Act (42 U.S.C. 1396o) is amended in each of 
     subsections (a)(2)(B) and (b)(2)(B) by inserting ``, and 
     counseling for cessation of tobacco use (as defined in 
     section 1905(x))'' after ``complicate the pregnancy''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after the date that 
     is 1 year after the date of enactment of this Act.

     SEC. 5. PROMOTING CESSATION OF TOBACCO USE UNDER THE MATERNAL 
                   AND CHILD HEALTH SERVICES BLOCK GRANT PROGRAM.

       (a) Quality Maternal and Child Health Services Includes 
     Tobacco Cessation Counseling and Medications.--
       (1) In general.--Section 501 of the Social Security Act (42 
     U.S.C. 701) is amended by adding at the end the following new 
     subsection:
       ``(c) For purposes of this title, counseling for cessation 
     of tobacco use (as defined in section 1905(x)), drugs and 
     biologicals used to promote smoking cessation, and the 
     inclusion of antitobacco messages in health promotion 
     counseling shall be considered to be part of quality maternal 
     and child health services.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect on the date that is 1 year after the date 
     of enactment of this Act.

[[Page S12615]]

       (b) Evaluation of National Core Performance Measures.--
       (1) In general.--The Administrator of the Health Resources 
     and Services Administration shall assess the current national 
     core performance measures and national core outcome measures 
     utilized under the Maternal and Child Health Block Grant 
     under title V of the Social Security Act (42 U.S.C. 701 et 
     seq.) for purposes of expanding such measures to include some 
     of the known causes of low birthweight and prematurity, 
     including the percentage of infants born to pregnant women 
     who smoked during pregnancy.
       (2) Report.--Not later than 1 year after the date of 
     enactment of this Act, the Administrator of the Health 
     Resources and Services Administration shall submit to the 
     appropriate committees of Congress a report concerning the 
     results of the evaluation conducted under paragraph (1).

     SEC. 6. STATE OPTION TO PROVIDE FAMILY PLANNING SERVICES AND 
                   SUPPLIES TO INDIVIDUALS WITH INCOMES THAT DO 
                   NOT EXCEED A STATE'S INCOME ELIGIBILITY LEVEL 
                   FOR MEDICAL ASSISTANCE.

       (a) In General.--Title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) is amended--
       (1) by redesignating section 1935 as section 1936; and
       (2) by inserting after section 1934 the following new 
     section:


    ``state option to provide family planning services and supplies

       ``Sec. 1935. (a) In General.--Subject to subsections (b) 
     and (c), a State may elect (through a State plan amendment) 
     to make medical assistance described in section 1905(a)(4)(C) 
     available to any individual whose family income does not 
     exceed the greater of--
       ``(1) 185 percent of the income official poverty line (as 
     defined by the Office of Management and Budget, and revised 
     annually in accordance with section 673(2) of the Omnibus 
     Budget Reconciliation Act of 1981) applicable to a family of 
     the size involved; or
       ``(2) the eligibility income level (expressed as a 
     percentage of such poverty line) that has been specified 
     under a waiver authorized by the Secretary or under section 
     1902(r)(2)), as of October 1, 2003, for an individual to be 
     eligible for medical assistance under the State plan.
       ``(b) Comparability.--Medical assistance described in 
     section 1905(a)(4)(C) that is made available under a State 
     plan amendment under subsection (a) shall--
       ``(1) not be less in amount, duration, or scope than the 
     medical assistance described in that section that is made 
     available to any other individual under the State plan; and
       ``(2) be provided in accordance with the restrictions on 
     deductions, cost sharing, or similar charges imposed under 
     section 1916(a)(2)(D).
       ``(c) Option To Extend Coverage During a Post-Eligibility 
     Period.--
       ``(1) Initial period.--A State plan amendment made under 
     subsection (a) may provide that any individual who was 
     receiving medical assistance described in section 
     1905(a)(4)(C) as a result of such amendment, and who becomes 
     ineligible for such assistance because of hours of, or income 
     from, employment, may remain eligible for such medical 
     assistance through the end of the 6-month period that begins 
     on the first day the individual becomes so ineligible.
       ``(2) Additional extension.--A State plan amendment made 
     under subsection (a) may provide that any individual who has 
     received medical assistance described in section 
     1905(a)(4)(C) during the entire 6-month period described in 
     paragraph (1) may be extended coverage for such assistance 
     for a succeeding 6-month period.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     apply to medical assistance provided on and after October 1, 
     2003.

     SEC. 7. STATE OPTION TO EXTEND THE POSTPARTUM PERIOD FOR 
                   PROVISION OF FAMILY PLANNING SERVICES AND 
                   SUPPLIES.

       (a) In General.--Section 1902(e)(5) of the Social Security 
     Act (42 U.S.C. 1396a(e)(5)) is amended--
       (1) by striking ``eligible under the plan, as though'' and 
     inserting ``eligible under the plan--
       ``(A) as though'';
       (2) by striking the period and inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(B) for medical assistance described in section 
     1905(a)(4)(C) for so long as the family income of such woman 
     does not exceed the maximum income level established by the 
     State for the woman to be eligible for medical assistance 
     under the State plan (as a result of pregnancy or 
     otherwise).''.
       (b) Effective Date.--The amendments made by subsection (a) 
     apply to medical assistance provided on and after October 1, 
     2003.

     SEC. 8. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP COVERAGE TO 
                   CHILDREN WHO HAVE OTHER HEALTH COVERAGE.

       (a) In General.--
       (1) SCHIP.--
       (A) State option to provide wrap-around coverage.--Section 
     2110(b) of the Social Security Act (42 U.S.C. 1397jj(b)) is 
     amended--
       (i) in paragraph (1)(C), by inserting ``, subject to 
     paragraph (5),'' after ``under title XIX or''; and
       (ii) by adding at the end the following:
       ``(5) State option to provide wrap-around coverage.--A 
     State may waive the requirement of paragraph (1)(C) that a 
     targeted low-income child may not be covered under a group 
     health plan or under health insurance coverage, if the State 
     satisfies the conditions described in subsection (c)(8). The 
     State may waive such requirement in order to provide--
       ``(A) services for a child with special health care needs; 
     or
       ``(B) all services.
     In waiving such requirement, a State may limit the 
     application of the waiver to children whose family income 
     does not exceed a level specified by the State, so long as 
     the level so specified does not exceed the maximum income 
     level otherwise established for other children under the 
     State child health plan .''.
       (B) Conditions described.--Section 2105(c) of the Social 
     Security Act (42 U.S.C. 1397ee(c)) is amended by adding at 
     the end the following:
       ``(8) Conditions for provision of wrap-around coverage.--
     For purposes of section 2110(b)(5), the conditions described 
     in this paragraph are the following:
       ``(A) Income eligibility.--The State child health plan 
     (whether implemented under title XIX or this XXI)--
       ``(i) has the highest income eligibility standard permitted 
     under this title as of January 1, 2003;
       ``(ii) subject to subparagraph (B), does not limit the 
     acceptance of applications for children; and
       ``(iii) provides benefits to all children in the State who 
     apply for and meet eligibility standards.
       ``(B) No waiting list imposed.--With respect to children 
     whose family income is at or below 200 percent of the poverty 
     line, the State does not impose any numerical limitation, 
     waiting list, or similar limitation on the eligibility of 
     such children for child health assistance under such State 
     plan.
       ``(C) No more favorable treatment.--The State child health 
     plan may not provide more favorable coverage of dental 
     services to the children covered under section 2110(b)(5) 
     than to children otherwise covered under this title.''.
       (C) State option to waive waiting period.--Section 
     2102(b)(1)(B) of the Social Security Act (42 U.S.C. 
     1397bb(b)(1)(B)), as amended by section 2(b)(3)(B), is 
     amended--
       (i) in clause (ii), by striking ``, and'' at the end and 
     inserting a semicolon;
       (ii) in clause (iii), by striking the period at the end and 
     inserting ``; and''; and
       (iii) by adding at the end the following new clause:
       ``(iv) at State option, may not apply a waiting period in 
     the case of a child described in section 2110(b)(5), if the 
     State satisfies the requirements of section 2105(c)(8).''.
       (2) Application of enhanced match under medicaid.--Section 
     1905 of the Social Security Act (42 U.S.C. 1396d), as amended 
     by section 2(a)(2), is amended--
       (A) in subsection (b), in the fourth sentence, by striking 
     ``or (u)(4)'' and inserting ``(u)(4), or (u)(5)''; and
       (B) in subsection (u)--
       (i) by redesignating paragraph (5) as paragraph (6); and
       (ii) by inserting after paragraph (4) the following:
       ``(5) For purposes of subsection (b), the expenditures 
     described in this paragraph are expenditures for items and 
     services for children described in section 2110(b)(5), but 
     only in the case of a State that satisfies the requirements 
     of section 2105(c)(8).''.
       (3) Application of secondary payor provisions.--Section 
     2107(e)(1) of the Social Security Act (42 U.S.C. 
     1397gg(e)(1)), as amended by section 3(b), is amended by 
     adding at the end the following:
       ``(F) Section 1902(a)(25) (relating to coordination of 
     benefits and secondary payor provisions) with respect to 
     children covered under a waiver described in section 
     2110(b)(5).''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on January 1, 2003, and shall apply to 
     child health assistance and medical assistance provided on or 
     after that date.

  Mr. LUGAR. Mr. President, I am pleased to introduce with my 
colleagues Senator Lincoln and Senator Bingaman, the Prevent Pre-
maturity and Improve Child Health Act.
  Pre-maturity has been escalating steadily and alarmingly over the 
past two decades. Between 1981 and 2001, the rate of premature births 
rose from 9.4 percent to 11.9 percent, an increase of more than 27 
percent. In 2001, more than 476,000 babies were born prematurely.
  Pre-maturity is the leading cause of infant death in the first month 
of life. Babies born too early are more likely than full-term infants 
to face serious multiple health problems following delivery. the health 
problems facing many of these children include cerebral palsy, mental 
retardation, chronic lung disease, and vision and hearing loss. If we 
are able to reduce the number of premature births we will be able to 
improve the health of hundreds of thousands of infants born each year.
  The goal of the ``Prevent Pre-maturity and Improve Child Health Act'' 
is

[[Page S12616]]

to give States increased flexibility and the Federal resources needed 
to improve access to prenatal care for low-income pregnant women and 
their children.
  Among other things, the bill allows States the option of covering 
legal immigrant pregnant women under Medicaid. It also promotes new 
programs and more coverage for tobacco cessation in Medicaid, and 
Maternal Child Health block grant programs, and allows States the 
option of providing wrap-around SCHIP coverage for special needs 
children who have another source of health insurance.
  Our bill has the potential to make a real difference in many lives. I 
am pleased that we are able to introduce this bill in conjunction with 
the March of Dimes kick off of their new campaign on pre-maturity 
awareness and hope that our colleagues will consider joining us in this 
effort.
                                 ______