II

106TH CONGRESS

1ST SESSION S. 110

To amend title XIX of the Social Security Act to provide medical assistance

for breast and cervical cancer-related treatment services to certain women

screened and found to have breast or cervical cancer under a federally

funded screening program.

IN THE SENATE OF THE UNITED STATES

JANUARY 19, 1999

Mr. SMITH of Oregon 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

medical assistance for breast and cervical cancer-related

treatment services to certain women screened and found

to have breast or cervical cancer under a federally funded

screening program.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Breast and Cervical

5 Cancer Treatment Act of 1999’’.
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1 SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN

2 BREAST OR CERVICAL CANCER PATIENTS.

3 (a) COVERAGE AS OPTIONAL CATEGORICALLY

4 NEEDY GROUP.—Section 1902(a)(10)(A)(ii) of the Social

5 Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is

6 amended—

7 (1) in subclause (XIII), by striking ‘‘or’’ at the

8 end;

9 (2) in subclause (XIV), by adding ‘‘or’’ at the

10 end; and

11 (3) by adding at the end the following:

12 ‘‘(XV) who are described in sub13 section (aa)(1) (relating to certain

14 breast or cervical cancer patients);’’.

15 (b) GROUP AND BENEFIT DESCRIBED.—Section

16 1902 of the Social Security Act (42 U.S.C. 1396a) is

17 amended by adding at the end the following:

18 ‘‘(aa)(1) Individuals described in this paragraph are

19 individuals who—

20 ‘‘(A) are not described in subsection

21 (a)(10)(A)(i);

22 ‘‘(B) have not attained age 65;

23 ‘‘(C) satisfy income and resource requirements

24 to be treated as a low-income woman for purposes

25 of being given priority under section 1504 of the

26 Public Health Service Act (42 U.S.C. 300n); and
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1 ‘‘(D) are not otherwise covered under creditable

2 coverage, as defined in section 2701(c) of the Public

3 Health Service Act (45 U.S.C. 300gg(c)).

4 ‘‘(2) For purposes of this title, the term ‘breast or

5 cervical cancer-related treatment services’ means services

6 that are medically necessary or appropriate for the treat7 ment of breast or cervical cancer and complications arising

8 from such treatment and for which medical assistance is

9 made available under the State plan to individuals de10 scribed in subsection (a)(10)(A)(i).’’.

11 (c) PRESUMPTIVE ELIGIBILITY.—

12 (1) IN GENERAL.—Title XIX of the Social Se13 curity Act (42 U.S.C. 1396 et seq.) is amended by

14 inserting after section 1920A the following:

15 ‘‘PRESUMPTIVE ELIGIBILITY FOR CERTAIN BREAST OR

16 CERVICAL CANCER PATIENTS

17 ‘‘SEC. 1920B. (a) STATE OPTION.—A State plan ap18 proved under section 1902 may provide for making medi19 cal assistance for breast or cervical cancer-related treat20 ment services available to an individual described in sec21 tion 1902(aa)(1) (relating to certain breast or cervical

22 cancer patients) during a presumptive eligibility period.

23 ‘‘(b) DEFINITIONS.—For purposes of this section:

24 ‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The

25 term ‘presumptive eligibility period’ means, with re-
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1 spect to an individual described in subsection (a),

2 the period that—

3 ‘‘(A) begins with the date on which a

4 qualified entity determines, on the basis of pre5 liminary information, that the individual is de6 scribed in section 1902(aa)(1), and

7 ‘‘(B) ends with (and includes) the earlier

8 of—

9 ‘‘(i) the day on which a determination

10 is made with respect to the eligibility of

11 such individual for services under the State

12 plan, or

13 ‘‘(ii) in the case of such an individual

14 who does not file an application by the last

15 day of the month following the month dur16 ing which the entity makes the determina17 tion referred to in subparagraph (A), such

18 last day.

19 ‘‘(2) QUALIFIED ENTITY.—

20 ‘‘(A) IN GENERAL.—Subject to subpara21 graph (B), the term ‘qualified entity’ means

22 any entity that—

23 ‘‘(i) is eligible for payments under a

24 State plan approved under this title and
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1 provides breast or cervical cancer-related

2 treatment services; and

3 ‘‘(ii) is determined by the State agen4 cy to be capable of making determinations

5 of the type described in paragraph (1)(A).

6 ‘‘(B) REGULATIONS.—The Secretary may

7 issue regulations further limiting those entities

8 that may become qualified entities in order to

9 prevent fraud and abuse and for other reasons.

10 ‘‘(C) RULE OF CONSTRUCTION.—Nothing

11 in this paragraph shall be construed as prevent12 ing a State from limiting the classes of entities

13 that may become qualified entities, consistent

14 with any limitations imposed under subpara15 graph (B).

16 ‘‘(c) ADMINISTRATION.—

17 ‘‘(1) IN GENERAL.—The State agency shall pro18 vide qualified entities with—

19 ‘‘(A) such forms as are necessary for an

20 application to be made by an individual de21 scribed in subsection (a) for medical assistance

22 under the State plan, and

23 ‘‘(B) information on how to assist such in24 dividuals in completing and filing such forms.
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1 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali2 fied entity that determines under subsection

3 (b)(1)(A) that an individual described in subsection

4 (a) is presumptively eligible for medical assistance

5 for breast or cervical cancer-related treatment serv6 ices under a State plan shall—

7 ‘‘(A) notify the State agency of the deter8 mination within 5 working days after the date

9 on which determination is made, and

10 ‘‘(B) inform such individual at the time

11 the determination is made that an application

12 for medical assistance under the State plan is

13 required to be made by not later than the last

14 day of the month following the month during

15 which the determination is made.

16 ‘‘(3) APPLICATION FOR MEDICAL ASSIST17 ANCE.—In the case of an individual described in

18 subsection (a) who is determined by a qualified en19 tity to be presumptively eligible for medical assist20 ance for breast or cervical cancer-related treatment

21 services under a State plan, the individual shall

22 apply for medical assistance under such plan by not

23 later than the last day of the month following the

24 month during which the determination is made.
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1 ‘‘(d) PAYMENT.—Notwithstanding any other provi2 sion of this title, medical assistance for breast or cervical

3 cancer-related treatment services that—

4 ‘‘(1) are furnished to an individual described in

5 subsection (a)—

6 ‘‘(A) during a presumptive eligibility pe7 riod,

8 ‘‘(B) by a entity that is eligible for pay9 ments under the State plan; and

10 ‘‘(2) are included in the care and services cov11 ered by the State plan;

12 shall be treated as medical assistance provided by such

13 plan for purposes of section 1903(a)(5)(B).’’.

14 (2) PRESUMPTIVE ELIGIBILITY CONFORMING

15 AMENDMENTS.—

16 (A) Section 1902(a)(47) of the Social Se17 curity Act (42 U.S.C. 1396a(a)(47)) is amend18 ed by inserting before the semicolon at the end

19 the following: ‘‘and provide for making medical

20 assistance for breast or cervical cancer-related

21 treatment services available to individuals de22 scribed in subsection (a) of section 1920B dur23 ing a presumptive eligibility period in accord24 ance with such section’’.
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1 (B) Section 1903(u)(1)(D)(v) of such Act

2 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended—

3 (i) by striking ‘‘or for’’ and inserting

4 ‘‘, for’’; and

5 (ii) by inserting before the period the

6 following: ‘‘, or for medical assistance for

7 breast or cervical cancer-related treatment

8 services provided to an individual described

9 in subsection (a) of section 1920B during

10 a presumptive eligibility period under such

11 section’’.

12 (d) ENHANCED MATCH.—Section 1903(a)(5) of the

13 Social Security Act (42 U.S.C. 1396b(a)(5)) is amended—

14 (1) by striking ‘‘an’’ and inserting ‘‘(A) an’’;

15 (2) by adding ‘‘plus’’ after the semicolon; and

16 (3) by adding at the end the following:

17 ‘‘(B) an amount equal to 75 percent of the

18 sums expended during such quarter which are at19 tributable to the offering, arranging, and furnishing

20 (directly or on a contract basis) of breast or cervical

21 cancer-related treatment services; plus’’.

22 (e) LIMITATION ON BENEFITS.—Section 1902(a)(10)

23 of the Social Security Act (42 U.S.C. 1396a(a)(10)) is

24 amended in the matter following subparagraph (F)—
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1 (1) by striking ‘‘and (XIII)’’ and inserting

2 ‘‘(XIII)’’; and

3 (2) by inserting before the semicolon at the end

4 the following: ‘‘, and (XIV) the medical assistance

5 made available to an individual described in sub6 section (aa)(1) who is eligible for medical assistance

7 only because of subparagraph (A)(ii)(XV) shall be

8 limited to medical assistance for breast or cervical

9 cancer-related treatment services’’.

10 (f) CONFORMING AMENDMENTS.—Section 1905(a) of

11 the Social Security Act (42 U.S.C. 1396d(a)) is amended

12 in the matter preceding paragraph (1)—

13 (1) in clause (x), by striking ‘‘or’’ at the end;

14 (2) in clause (xi), by adding ‘‘or’’ at the end;

15 and

16 (3) by inserting after clause (xi) the following:

17 ‘‘(xii) individuals described in section

18 1902(aa)(1),’’.

19 (g) EFFECTIVE DATE.—The amendments made by

20 this section apply to medical assistance furnished on or

21 after October 1, 2000, without regard to whether or not

22 final regulations to carry out such amendments have been

23 promulgated by such date.

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