Authorizes a State to apply to the Secretary of Health and Human Services for approval of a demonstration project to provide Medicaid coverage to up to a specified maximum number of children with a potentially severe disability.
Amends SSA title V (Maternal and Child Health Services) to make appropriations to the Secretary for special projects of regional and national significance for development and support of family-to-family health information centers.
[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2274 Introduced in Senate (IS)]
106th CONGRESS
2d Session
S. 2274
To amend title XIX of the Social Security Act to provide families of
disabled children with the opportunity to purchase coverage under the
medicaid program for such children, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 22, 2000
Mr. Grassley (for himself, Mr. Kennedy, Mr. Jeffords, Mr. Harkin, Mr.
Reed, and Mr. Moynihan) introduced the following bill; which was read
twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide families of
disabled children with the opportunity to purchase coverage under the
medicaid program for such children, and for other purposes.
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 ``Family Opportunity Act of 2000''.
SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO PURCHASE
MEDICAID COVERAGE FOR SUCH CHILDREN.
(a) State Option To Allow Families of Disabled Children To Purchase
Medicaid Coverage for Such Children.--
(1) In general.--Section 1902 of the Social Security Act
(42 U.S.C. 1396a), as amended by the Foster Care Independence
Act of 1999 (Public Law 106-169; 113 Stat. 1822) and the Ticket
to Work and Work Incentives Improvement Act of 1999 (Public Law
106-170; 113 Stat. 1860), is amended--
(A) in subsection (a)(10)(A)(ii)--
(i) by striking ``or'' at the end of
subclause (XVI);
(ii) by adding ``or'' at the end of
subclause (XVII); and
(iii) by adding at the end the following
new subclause:
``(XVIII) who are disabled children
described in subsection (aa);''; and
(B) by adding at the end the following new
subsection:
``(aa)(1) Individuals described in this subsection are
individuals--
``(A) who have not attained 21 years of age;
``(B) who would be considered disabled under section
1614(a)(3)(C) (determined without regard to the reference to
age in that section) but for having family income or resources
(as determined under title XVI for children) that exceed the
requirements for receipt of supplemental security income
benefits; and
``(C) whose family income (as so determined) does not
exceed--
``(i) 600 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
``(ii) such higher percent of such poverty line as
a State may establish, except that no Federal financial
participation shall be provided under section 1903(a)
for any medical assistance provided to an individual
who would not be described in this subsection but for
this clause.
``(2) A State shall provide the same amount, duration, and scope of
medical assistance under the State plan to an individual described in
paragraph (1) who has attained age 18 but has not attained age 21 as
the State provides under the State plan to an individual who has not
attained age 18.''.
(2) Interaction with employer-sponsored family coverage.--
Section 1902(aa) of the Social Security Act (42 U.S.C.
1396a(aa)), as added by paragraph (1), is amended by adding at
the end the following new paragraph:
``(3)(A) If an employer of a parent or caretaker relative of an
individual described in paragraph (1) offers family coverage under a
group health plan (as defined in section 2791(a) of the Public Health
Service Act), the State shall--
``(i) require such parent or caretaker relative to apply
for, enroll in, and pay premiums for, such coverage as a
condition of such parent's or caretaker relative's child being
or remaining eligible for medical assistance under subsection
(a)(10)(A)(ii)(XVIII) if the parent or caretaker relative is
determined eligible for such coverage and the employer
contributes more than 40 percent of the total cost of annual
premiums for such coverage; and
``(ii) if such coverage is obtained--
``(I) subject to paragraph (2) of section 1916(h),
reduce the premium imposed by the State under that
section (if any) in an amount that is based on the
amount of the parent or caretaker relative's
contribution for such coverage, the actuarial value of
the medical assistance provided to such parent or
caretaker relative's child, or both; and
``(II) treat such coverage as a third party
liability under subsection (a)(25).
``(B) In the case of a parent or caretaker relative to which
subparagraph (A) applies--
``(i) if the family income (as so determined) of such
parent or caretaker relative does not exceed 300 percent of the
income official poverty line (as so defined), a State may
provide for payment of any portion of the premium for such
family coverage that the parent or caretaker relative is
required to pay for a period not to exceed 12 months; and
``(ii) any payments made by the State under clause (i)
shall be considered, for purposes of section 1903(a), to be
payments for medical assistance.''.
(b) State Option To Impose Income-Related Premiums.--Section 1916
of the Social Security Act (42 U.S.C. 1396o), as amended by the Ticket
to Work and Work Incentives Improvement Act of 1999 (Public Law 106-
170; 113 Stat. 1860), is amended--
(1) in subsection (a), by striking ``subsection (g)'' and
inserting ``subsections (g) and (h)''; and
(2) by adding at the end the following new subsection:
``(h)(1) With respect to disabled children provided medical
assistance under section 1902(a)(10)(A)(ii)(XVIII), subject to
paragraph (2), a State may (in a uniform manner for such children)
require the families of such children to pay monthly premiums set on a
sliding scale based on family income (as determined under title XVI for
children).
``(2) A premium requirement imposed under paragraph (1) may only
apply to the extent that--
``(A) the aggregate amount of such premium and any premium
that the parent or caretaker relative is required to pay for
family coverage under section 1902(aa)(3)(A)(i) does not exceed
7.5 percent (5 percent, in the case of a family described in
section 1902(aa)(3)(B)(i)) of the family's income; and
``(B) the requirement is imposed consistent with section
1902(aa)(3)(A)(ii)(I).
``(3) A State shall not require prepayment of a premium imposed
pursuant to paragraph (1) and shall not terminate eligibility of a
child under section 1902(a)(10)(A)(ii)(XVIII) for medical assistance
under this title on the basis of failure to pay any such premium until
such failure continues for a period of not less than 60 days from the
date on which the premium became past due. The State may waive payment
of any such premium in any case where the State determines that
requiring such payment would create an undue hardship.''.
(c) Increased Federal Financial Assistance for Administrative
Costs.--Section 1903(a)(7) of the Social Security Act (42 U.S.C.
1396b(a)(7)) is amended--
(1) by inserting ``(A)'' after ``(7)'';
(2) by striking the period and inserting ``, and''; and
(3) by adding at the end the following new subclause:
``(B)(i) 90 percent of the sums expended during such a
quarter within the twelve-quarter period beginning with the
first quarter in which a payment is made to the State pursuant
to this subparagraph, and
``(ii) 75 percent of the sums expended during each
succeeding calendar quarter,
with respect to administrative costs incurred during such
quarter (as found necessary by the Secretary) for providing
medical assistance to disabled children under section
1902(a)(10)(A)(ii)(XVIII).''.
(d) Conforming Amendment.--Section 1903(f)(4) of the Social
Security Act (42 U.S.C. 1396b(f)(4)) is amended in the matter preceding
subparagraph (A) by inserting ``1902(a)(10)(A)(ii)(XVIII)'' before
``1905(p)(1)''.
(e) Effective Date.--The amendments made by this section shall
apply to medical assistance for items and services furnished on or
after October 1, 2000.
SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR
INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED
SERVICES WAIVERS.
(a) In General.--Section 1915(c) of the Social Security Act (42
U.S.C. 1396n(c)) is amended--
(1) in paragraph (1)--
(A) in the first sentence, by inserting ``, or
inpatient psychiatric hospital services for individuals
under age 21,'' after ``intermediate care facility for
the mentally retarded''; and
(B) in the second sentence, by inserting ``, or
inpatient psychiatric hospital services for individuals
under age 21'' before the period;
(2) in paragraph (2)(B), by striking ``or services in an
intermediate care facility for the mentally retarded'' each
place it appears and inserting ``, services in an intermediate
care facility for the mentally retarded, or inpatient
psychiatric hospital services for individuals under age 21'';
(3) by striking paragraph (2)(C) and inserting the
following:
``(C) such individuals who are determined to be likely to
require the level of care provided in a hospital, nursing
facility, or intermediate care facility for the mentally
retarded, or inpatient psychiatric hospital services for
individuals under age 21, are informed of the feasible
alternatives, if available under the waiver, at the choice of
such individuals, to the provision of inpatient hospital
services, nursing facility services, services in an
intermediate care facility for the mentally retarded, or
inpatient psychiatric hospital services for individuals under
age 21;''; and
(4) in paragraph (7)(A)--
(A) by inserting ``, or inpatient psychiatric
hospital services for individuals under age 21,'' after
``intermediate care facility for the mentally
retarded''; and
(B) by inserting ``, or who would require inpatient
psychiatric hospital services for individuals under age
21'' before the period.
(b) Effective Date.--The amendments made by subsection (a) apply
with respect to medical assistance provided on or after October 1,
2000.
SEC. 4. DEMONSTRATION OF COVERAGE UNDER THE MEDICAID PROGRAM OF
CHILDREN WITH POTENTIALLY SEVERE DISABILITIES.
(a) State Application.--A State may apply to the Secretary of
Health and Human Services (in this section referred to as the
``Secretary'') for approval of a demonstration project (in this section
referred to as a ``demonstration project'') under which up to a
specified maximum number of children with a potentially severe
disability (as defined in subsection (b)) are provided medical
assistance under the State medicaid plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(b) Child With a Potentially Severe Disability Defined.--
(1) In general.--In this section, the term ``child with a
potentially severe disability'' means, with respect to a
demonstration project, an individual who--
(A) has not attained 21 years of age;
(B) has a physical or mental condition, disease,
disorder (including a congenital birth defect), injury,
or developmental disability that was incurred before
the individual attained such age; and
(C) is reasonably expected, but for the receipt of
medical assistance under the State medicaid plan, to
reach the level of disability defined under section
1614(a)(3) of the Social Security Act (42 U.S.C.
1382c(a)(3)), (determined without regard to the
reference to age in subparagraph (C) of that section).
(2) Exception.--Such term does not include an individual
who would be considered disabled under section 1614(a)(3)(C) of
the Social Security Act (42 U.S.C. 1382c(a)(3)(C)) (determined
without regard to the reference to age in that section).
(c) Approval of Demonstration Projects.--
(1) In general.--Subject to paragraph (3), the Secretary
shall approve applications under subsection (a) that meet the
requirements of paragraph (2) and such additional terms and
conditions as the Secretary may require. The Secretary may
waive the requirement of section 1902(a)(1) of the Social
Security Act (42 U.S.C. 1396a(a)(1)) to allow for sub-State
demonstrations.
(2) Terms and conditions of demonstration projects.--The
Secretary may not approve a demonstration project under this
section unless the State provides assurances satisfactory to
the Secretary that the following conditions are or will be met:
(A) Independent evaluation.--The State provides for
an independent evaluation of the project to be
conducted during fiscal year 2005.
(B) Consultation for development of criteria.--The
State consults with appropriate pediatric health
professionals in establishing the criteria for
determining whether a child has a potentially severe
disability.
(C) Annual report.--The State submits an annual
report to the Secretary (in a uniform form and manner
established by the Secretary) on the use of funds
provided under the grant that includes the following:
(i) Enrollment and financial statistics
on--
(I) the total number of children
with a potentially severe disability
enrolled in the demonstration project,
disaggregated by disability;
(II) the services provided by
category or code and the cost of each
service so categorized or coded; and
(III) the number of children
enrolled in the demonstration project
who also receive services through
private insurance.
(ii) With respect to the report submitted
for fiscal year 2005, the results of the
independent evaluation conducted under
subparagraph (A).
(iii) Such additional information as the
Secretary may require.
(3) Limitations on federal funding.--
(A) Appropriation.--
(i) In general.--Out of any funds in the
Treasury not otherwise appropriated, there is
appropriated to carry out this section
$50,000,000 for each of fiscal years 2001
through 2006.
(ii) Budget authority.--Clause (i)
constitutes budget authority in advance of
appropriations Acts and represents the
obligation of the Federal Government to provide
for the payment of the amounts appropriated
under clause (i).
(B) Limitation on payments.--In no case may--
(i) the aggregate amount of payments made
by the Secretary to States under this section
exceed $300,000,000;
(ii) the aggregate amount of payments made
by the Secretary to States for administrative
expenses relating to the evaluations and annual
reports required under subparagraphs (B) and
(D) of paragraph (2) exceed $6,000,000 of such
$300,000,000; or
(iii) payments be provided by the Secretary
for a fiscal year after fiscal year 2009.
(C) Funds allocated to states.--
(i) In general.--The Secretary shall
allocate funds to States based on their
applications and the availability of funds. In
making such allocations, the Secretary shall
ensure an equitable distribution of funds among
States with large populations and States with
small populations.
(ii) Availability.--Funds allocated to a
State under a grant made under this section for
a fiscal year shall remain available until
expended.
(D) Funds not allocated to states.--Funds not
allocated to States in the fiscal year for which they
are appropriated shall remain available in succeeding
fiscal years for allocation by the Secretary using the
allocation formula established under this section.
(E) Payments to states.--The Secretary shall pay to
each State with a demonstration project approved under
this section, from its allocation under subparagraph
(C), an amount for each quarter equal to the Federal
medical assistance percentage (as defined in section
1905(b) of the Social Security Act (42 U.S.C.
1395d(b))) of expenditures in the quarter for medical
assistance provided to children with a potentially
severe disability.
(d) Recommendation.--Not later than October 1, 2004, the Secretary
shall submit a recommendation to the Committee on Commerce of the House
of Representatives and the Committee on Finance of the Senate regarding
whether the demonstration project established under this section should
be continued after fiscal year 2006.
(e) State Defined.--In this section, the term ``State'' has the
meaning given such term for purposes of title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
SEC. 5. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH INFORMATION
CENTERS.
Section 501 of the Social Security Act (42 U.S.C. 701) is amended
by adding at the end the following new subsection:
``(c)(1)(A) In addition to amounts appropriated under subsection
(a) and retained under section 502(a)(1) for the purpose of carrying
out activities described in subsection (a)(2), there is appropriated to
the Secretary, out of any money in the Treasury not otherwise
appropriated, for the purpose of enabling the Secretary (through
grants, contracts, or otherwise) to provide for special projects of
regional and national significance for the development and support of
family-to-family health information centers described in paragraph (2),
$10,000,000 for each of fiscal years 2001 through 2006.
``(B) Funds appropriated under subparagraph (A) shall remain
available until expended.
``(2) The family-to-family health information centers described in
this paragraph are centers that--
``(A) assist families of children with disabilities or
special health care needs to make informed choices about health
care in order to promote good treatment decisions, cost-
effectiveness, and improved health outcomes for such children;
``(B) provide information regarding the health care needs
of, and resources available for, children with disabilities or
special health care needs;
``(C) identify successful health delivery models for such
children;
``(D) develop with representatives of health care
providers, managed care organizations, health care purchasers,
and appropriate State agencies a model for collaboration
between families of such children and health professionals;
``(E) provide training and guidance regarding caring for
such children;
``(F) conduct outreach activities to the families of such
children, health professionals, schools, and other appropriate
entities and individuals; and
``(G) are staffed by families of children with disabilities
or special health care needs who have expertise in Federal and
State public and private health care systems and health
professionals.
``(3) The provisions of this title that are applicable to the funds
made available to the Secretary under section 502(a)(1) apply in the
same manner to funds made available to the Secretary under paragraph
(1).''.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S1607)
Read twice and referred to the Committee on Finance.
Committee on the Budget. Hearings held. Hearings printed: S.Hrg. 106-612.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line