I

106TH CONGRESS

2D SESSION H. R. 4825

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 HOUSE OF REPRESENTATIVES

JULY 12, 2000

Mr. SESSIONS (for himself, Mr. WAXMAN, Mr. UPTON, Mr. BARRETT of Wisconsin, Ms. PRYCE of Ohio, Mr. STRICKLAND, Mr. HAYWORTH, Mr.

BROWN of Ohio, Mr. DREIER, Mr. LAZIO, Mr. DINGELL, Mr. DOGGETT,

Mr. RAMSTAD, Mr. NUSSLE, Mr. NETHERCUTT, Mr. GILCHREST, and

Mr. TAUZIN) introduced the following bill; which was referred to the

Committee on Commerce

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.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Family Opportunity Act of 2000’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Opportunity for families of disabled children to purchase medicaid coverage for such children.

Sec. 3. Treatment of inpatient psychiatric hospital services for individuals

under age 21 in home or community-based services waivers.

Sec. 4. Demonstration of coverage under the medicaid program of children with

potentially severe disabilities.

Sec. 5. Development and support of family-to-family health information centers.

Sec. 6. Restoration of medicaid eligibility for certain SSI beneficiaries.

3 SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHIL4 DREN TO PURCHASE MEDICAID COVERAGE

5 FOR SUCH CHILDREN.

6 (a) STATE OPTION TO ALLOW FAMILIES OF DIS7 ABLED CHILDREN TO PURCHASE MEDICAID COVERAGE

8 FOR SUCH CHILDREN.—

9 (1) IN GENERAL.—Section 1902 of the Social

10 Security Act (42 U.S.C. 1396a), as amended by the

11 Foster Care Independence Act of 1999 (Public Law

12 106–169; 113 Stat. 1822) and the Ticket to Work

13 and Work Incentives Improvement Act of 1999

14 (Public Law 106–170; 113 Stat. 1860), is

15 amended—

16 (A) in subsection (a)(10)(A)(ii)—

17 (i) by striking ‘‘or’’ at the end of sub18 clause (XVI);

19 (ii) by adding ‘‘or’’ at the end of sub20 clause (XVII); and
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1 (iii) by adding at the end the fol2 lowing new subclause:

3 ‘‘(XVIII) who are disabled chil4 dren described in subsection (aa);’’;

5 and

6 (B) by adding at the end the following new

7 subsection:

8 ‘‘(aa)(1) Individuals described in this subsection are

9 individuals—

10 ‘‘(A) who have not attained 21 years of age;

11 ‘‘(B) who would be considered disabled under

12 section 1614(a)(3)(C) (determined without regard to

13 the reference to age in that section) but for having

14 family income or resources (as determined under

15 title XVI for children) that exceed the requirements

16 for receipt of supplemental security income benefits;

17 and

18 ‘‘(C) whose family income (as so determined)

19 does not exceed—

20 ‘‘(i) 600 percent of the income official pov21 erty line (as defined by the Office of Manage22 ment and Budget, and revised annually in ac23 cordance with section 673(2) of the Omnibus

24 Budget Reconciliation Act of 1981) applicable

25 to a family of the size involved; or
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1 ‘‘(ii) such higher percent of such poverty

2 line as a State may establish, except that no

3 Federal financial participation shall be provided

4 under section 1903(a) for any medical assist5 ance provided to an individual who would not be

6 described in this subsection but for this clause.

7 ‘‘(2) A State shall provide the same amount, dura8 tion, and scope of medical assistance under the State plan

9 to an individual described in paragraph (1) who has at10 tained age 18 but has not attained age 21 as the State

11 provides under the State plan to an individual who has

12 not attained age 18.’’.

13 (2) INTERACTION WITH EMPLOYER-SPONSORED

14 FAMILY COVERAGE.—Section 1902(aa) of the Social

15 Security Act (42 U.S.C. 1396a(aa)), as added by

16 paragraph (1), is amended by adding at the end the

17 following new paragraph:

18 ‘‘(3)(A) If an employer of a parent or caretaker rel19 ative of an individual described in paragraph (1) offers

20 family coverage under a group health plan (as defined in

21 section 2791(a) of the Public Health Service Act), the

22 State may—

23 ‘‘(i) require such parent or caretaker relative to

24 apply for, enroll in, and pay premiums for, such cov25 erage as a condition of such parent’s or caretaker
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1 relative’s child being or remaining eligible for med2 ical assistance under subsection

3 (a)(10)(A)(ii)(XVIII) if the parent or caretaker rel4 ative is determined eligible for such coverage and the

5 employer contributes at least 50 percent of the total

6 cost of annual premiums for such coverage; and

7 ‘‘(ii) if such coverage is obtained—

8 ‘‘(I) subject to paragraph (2) of section

9 1916(h), reduce the premium imposed by the

10 State under that section (if any) in an amount

11 that reasonably reflects the premium contribu12 tion made by the family for private coverage on

13 behalf of a child with a disability; and

14 ‘‘(II) treat such coverage as a third party

15 liability under subsection (a)(25).

16 ‘‘(B) In the case of a parent or caretaker relative to

17 which subparagraph (A) applies—

18 ‘‘(i) if the family income (as so determined) of

19 such parent or caretaker relative does not exceed

20 300 percent of the income official poverty line (as so

21 defined), a State may provide for payment of any

22 portion of the annual premium for such family cov23 erage that the parent or caretaker relative is re24 quired to pay; and
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1 ‘‘(ii) any payments made by the State under

2 clause (i) shall be considered, for purposes of section

3 1903(a), to be payments for medical assistance.’’.

4 (b) STATE OPTION TO IMPOSE INCOME-RELATED

5 PREMIUMS.—Section 1916 of the Social Security Act (42

6 U.S.C. 1396o), as amended by the Ticket to Work and

7 Work Incentives Improvement Act of 1999 (Public Law

8 106–170; 113 Stat. 1860), is amended—

9 (1) in subsection (a), by striking ‘‘subsection

10 (g)’’ and inserting ‘‘subsections (g) and (h)’’; and

11 (2) by adding at the end the following new sub12 section:

13 ‘‘(h)(1) With respect to disabled children provided

14 medical assistance under section

15 1902(a)(10)(A)(ii)(XVIII), subject to paragraph (2), a

16 State may (in a uniform manner for such children) require

17 the families of such children to pay monthly premiums set

18 on a sliding scale based on family income (as determined

19 under title XVI for children).

20 ‘‘(2) A premium requirement imposed under para21 graph (1) may only apply to the extent that—

22 ‘‘(A) the aggregate amount of such premium

23 and any premium that the parent or caretaker rel24 ative is required to pay for family coverage under
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1 section 1902(aa)(3)(A)(i) does not exceed 5 percent

2 of the family’s income; and

3 ‘‘(B) the requirement is imposed consistent with

4 section 1902(aa)(3)(A)(ii)(I).

5 ‘‘(3) A State shall not require prepayment of a pre6 mium imposed pursuant to paragraph (1) and shall not

7 terminate eligibility of a child under section

8 1902(a)(10)(A)(ii)(XVIII) for medical assistance under

9 this title on the basis of failure to pay any such premium

10 until such failure continues for a period of not less than

11 60 days from the date on which the premium became past

12 due. The State may waive payment of any such premium

13 in any case where the State determines that requiring

14 such payment would create an undue hardship.’’.

15 (c) INCREASED FEDERAL FINANCIAL ASSISTANCE

16 FOR ADMINISTRATIVE COSTS.—Section 1903(a)(7) of the

17 Social Security Act (42 U.S.C. 1396b(a)(7)) is amended—

18 (1) by inserting ‘‘(A)’’ after ‘‘(7)’’;

19 (2) by striking the period and inserting ‘‘,

20 and’’; and

21 (3) by adding at the end the following new sub22 paragraph:

23 ‘‘(B) 90 percent of the sums expended during

24 such a quarter within the twelve-quarter period be-
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1 ginning with the first quarter in which a payment is

2 made to the State pursuant to this subparagraph.’’.

3 (d) CONFORMING AMENDMENT.—Section 1903(f)(4)

4 of the Social Security Act (42 U.S.C. 1396b(f)(4)) is

5 amended in the matter preceding subparagraph (A) by in6 serting ‘‘1902(a)(10)(A)(ii)(XVIII)’’ before ‘‘1905(p)(1)’’.

7 (e) EFFECTIVE DATE.—The amendments made by

8 this section shall apply to medical assistance for items and

9 services furnished on or after October 1, 2000.

10 SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOS11 PITAL SERVICES FOR INDIVIDUALS UNDER

12 AGE 21 IN HOME OR COMMUNITY-BASED

13 SERVICES WAIVERS.

14 (a) IN GENERAL.—Section 1915(c) of the Social Se15 curity Act (42 U.S.C. 1396n(c)) is amended—

16 (1) in paragraph (1)—

17 (A) in the first sentence, by inserting ‘‘, or

18 inpatient psychiatric hospital services for indi19 viduals under age 21,’’ after ‘‘intermediate care

20 facility for the mentally retarded’’; and

21 (B) in the second sentence, by inserting ‘‘,

22 or inpatient psychiatric hospital services for in23 dividuals under age 21’’ before the period;

24 (2) in paragraph (2)(B), by striking ‘‘or serv25 ices in an intermediate care facility for the mentally
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1 retarded’’ each place it appears and inserting ‘‘,

2 services in an intermediate care facility for the men3 tally retarded, or inpatient psychiatric hospital serv4 ices for individuals under age 21’’;

5 (3) by striking paragraph (2)(C) and inserting

6 the following:

7 ‘‘(C) such individuals who are determined to be

8 likely to require the level of care provided in a hos9 pital, nursing facility, or intermediate care facility

10 for the mentally retarded, or inpatient psychiatric

11 hospital services for individuals under age 21, are

12 informed of the feasible alternatives, if available

13 under the waiver, at the choice of such individuals,

14 to the provision of inpatient hospital services, nurs15 ing facility services, services in an intermediate care

16 facility for the mentally retarded, or inpatient psy17 chiatric hospital services for individuals under age

18 21;’’; and

19 (4) in paragraph (7)(A)—

20 (A) by inserting ‘‘, or inpatient psychiatric

21 hospital services for individuals under age 21,’’

22 after ‘‘intermediate care facility for the men23 tally retarded’’; and
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1 (B) by inserting ‘‘, or who would require

2 inpatient psychiatric hospital services for indi3 viduals under age 21’’ before the period.

4 (b) EFFECTIVE DATE.—The amendments made by

5 subsection (a) apply with respect to medical assistance

6 provided on or after October 1, 2000.

7 SEC. 4. DEMONSTRATION OF COVERAGE UNDER THE MED8 ICAID PROGRAM OF CHILDREN WITH POTEN9 TIALLY SEVERE DISABILITIES.

10 (a) STATE APPLICATION.—A State may apply to the

11 Secretary of Health and Human Services (in this section

12 referred to as the ‘‘Secretary’’) for approval of a dem13 onstration project (in this section referred to as a ‘‘dem14 onstration project’’) under which up to a specified max15 imum number of children with a potentially severe dis16 ability (as defined in subsection (b)) are provided medical

17 assistance under the State medicaid plan under title XIX

18 of the Social Security Act (42 U.S.C. 1396 et seq.).

19 (b) CHILD WITH A POTENTIALLY SEVERE DIS20 ABILITY DEFINED.—

21 (1) IN GENERAL.—In this section, the term

22 ‘‘child with a potentially severe disability’’ means,

23 with respect to a demonstration project, an indi24 vidual who—

25 (A) has not attained 6 years of age;
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1 (B) has a physical or mental condition,

2 disease, disorder (including a congenital birth

3 defect), injury, or developmental disability that

4 was incurred before the individual attained such

5 age; and

6 (C) is reasonably expected, but for the re7 ceipt of medical assistance under the State

8 medicaid plan, to reach the level of disability

9 defined under section 1614(a)(3) of the Social

10 Security Act (42 U.S.C. 1382c(a)(3)), (deter11 mined without regard to the reference to age in

12 subparagraph (C) of that section).

13 (2) EXCEPTION.—Such term does not include

14 an individual who would be considered disabled

15 under section 1614(a)(3)(C) of the Social Security

16 Act (42 U.S.C. 1382c(a)(3)(C)) (determined without

17 regard to the reference to age in that section).

18 (c) APPROVAL OF DEMONSTRATION PROJECTS.—

19 (1) IN GENERAL.—Subject to paragraph (3),

20 the Secretary shall approve applications under sub21 section (a) that meet the requirements of paragraph

22 (2) and such additional terms and conditions as the

23 Secretary may require. The Secretary may waive the

24 requirement of section 1902(a)(1) of the Social Se-
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1 curity Act (42 U.S.C. 1396a(a)(1)) to allow for sub2 State demonstrations.

3 (2) TERMS AND CONDITIONS OF DEMONSTRA4 TION PROJECTS.—The Secretary may not approve a

5 demonstration project under this section unless the

6 State provides assurances satisfactory to the Sec7 retary that the following conditions are or will be

8 met:

9 (A) INDEPENDENT EVALUATION.—The

10 State provides for an independent evaluation of

11 the project to be conducted during fiscal year

12 2005.

13 (B) CONSULTATION FOR DEVELOPMENT

14 OF CRITERIA.—The State consults with appro15 priate pediatric health professionals in estab16 lishing the criteria for determining whether a

17 child has a potentially severe disability.

18 (C) ANNUAL REPORT.—The State submits

19 an annual report to the Secretary (in a uniform

20 form and manner established by the Secretary)

21 on the use of funds provided under the grant

22 that includes the following:

23 (i) Enrollment and financial statistics

24 on—
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1 (I) the total number of children

2 with a potentially severe disability en3 rolled in the demonstration project,

4 disaggregated by disability;

5 (II) the services provided by cat6 egory or code and the cost of each

7 service so categorized or coded; and

8 (III) the number of children en9 rolled in the demonstration project

10 who also receive services through pri11 vate insurance.

12 (ii) With respect to the report sub13 mitted for fiscal year 2005, the results of

14 the independent evaluation conducted

15 under subparagraph (A).

16 (iii) Such additional information as

17 the Secretary may require.

18 (3) LIMITATIONS ON FEDERAL FUNDING.—

19 (A) APPROPRIATION.—

20 (i) IN GENERAL.—Out of any funds in

21 the Treasury not otherwise appropriated,

22 there is appropriated to carry out this sec23 tion $16,667,000 for each of fiscal years

24 2001 through 2006.
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1 (ii) BUDGET AUTHORITY.—Clause (i)

2 constitutes budget authority in advance of

3 appropriations Acts and represents the ob4 ligation of the Federal Government to pro5 vide for the payment of the amounts ap6 propriated under clause (i).

7 (B) LIMITATION ON PAYMENTS.—In no

8 case may—

9 (i) the aggregate amount of payments

10 made by the Secretary to States under this

11 section exceed $100,000,000;

12 (ii) the aggregate amount of payments

13 made by the Secretary to States for ad14 ministrative expenses relating to the eval15 uations and annual reports required under

16 subparagraphs (B) and (D) of paragraph

17 (2) exceed $2,000,000 of such

18 $100,000,000; or

19 (iii) payments be provided by the Sec20 retary for a fiscal year after fiscal year

21 2009.

22 (C) FUNDS ALLOCATED TO STATES.—

23 (i) IN GENERAL.—The Secretary shall

24 allocate funds to States based on their ap25 plications and the availability of funds. In
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1 making such allocations, the Secretary

2 shall ensure an equitable distribution of

3 funds among States with large populations

4 and States with small populations.

5 (ii) AVAILABILITY.—Funds allocated

6 to a State under a grant made under this

7 section for a fiscal year shall remain avail8 able until expended.

9 (D) FUNDS NOT ALLOCATED TO STATES.—

10 Funds not allocated to States in the fiscal year

11 for which they are appropriated shall remain

12 available in succeeding fiscal years for alloca13 tion by the Secretary using the allocation for14 mula established under this section.

15 (E) PAYMENTS TO STATES.—The Sec16 retary shall pay to each State with a dem17 onstration project approved under this section,

18 from its allocation under subparagraph (C), an

19 amount for each quarter equal to the Federal

20 medical assistance percentage (as defined in

21 section 1905(b) of the Social Security Act (42

22 U.S.C. 1395d(b))) of expenditures in the quar23 ter for medical assistance provided to children

24 with a potentially severe disability.
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1 (d) RECOMMENDATION.—Not later than October 1,

2 2004, the Secretary shall submit a recommendation to the

3 Committee on Commerce of the House of Representatives

4 and the Committee on Finance of the Senate regarding

5 whether the demonstration project established under this

6 section should be continued after fiscal year 2006.

7 (e) STATE DEFINED.—In this section, the term

8 ‘‘State’’ has the meaning given such term for purposes of

9 title XIX of the Social Security Act (42 U.S.C. 1396 et

10 seq.).

11 SEC. 5. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAM12 ILY HEALTH INFORMATION CENTERS.

13 Section 501 of the Social Security Act (42 U.S.C.

14 701) is amended by adding at the end the following new

15 subsection:

16 ‘‘(c)(1)(A) In addition to amounts appropriated

17 under subsection (a) and retained under section 502(a)(1)

18 for the purpose of carrying out activities described in sub19 section (a)(2), there is appropriated to the Secretary, out

20 of any money in the Treasury not otherwise appropriated,

21 for the purpose of enabling the Secretary (through grants,

22 contracts, or otherwise) to provide for special projects of

23 regional and national significance for the development and

24 support of family-to-family health information centers de-
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1 scribed in paragraph (2), $10,000,000 for each of fiscal

2 years 2001 through 2006.

3 ‘‘(B) Funds appropriated under subparagraph (A)

4 shall remain available until expended.

5 ‘‘(2) The family-to-family health information centers

6 described in this paragraph are centers that—

7 ‘‘(A) assist families of children with disabilities

8 or special health care needs to make informed

9 choices about health care in order to promote good

10 treatment decisions, cost-effectiveness, and improved

11 health outcomes for such children;

12 ‘‘(B) provide information regarding the health

13 care needs of, and resources available for, children

14 with disabilities or special health care needs;

15 ‘‘(C) identify successful health delivery models

16 for such children;

17 ‘‘(D) develop with representatives of health care

18 providers, managed care organizations, health care

19 purchasers, and appropriate State agencies a model

20 for collaboration between families of such children

21 and health professionals;

22 ‘‘(E) provide training and guidance regarding

23 caring for such children;
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1 ‘‘(F) conduct outreach activities to the families

2 of such children, health professionals, schools, and

3 other appropriate entities and individuals; and

4 ‘‘(G) are staffed by families of children with

5 disabilities or special health care needs who have ex6 pertise in Federal and State public and private

7 health care systems and health professionals.

8 ‘‘(3) The provisions of this title that are applicable

9 to the funds made available to the Secretary under section

10 502(a)(1) apply in the same manner to funds made avail11 able to the Secretary under paragraph (1).’’.

12 SEC. 6. RESTORATION OF MEDICAID ELIGIBILITY FOR CER13 TAIN SSI BENEFICIARIES.

14 (a) IN GENERAL.—Section 1902(a)(10)(A)(i)(II) of

15 the Social Security Act (42 U.S.C.

16 1396a(a)(10)(A)(i)(II)) is amended—

17 (1) by inserting ‘‘(aa)’’ after ‘‘(II)’’;

18 (2) by striking ‘‘or who are’’ and inserting

19 ‘‘(bb) who are’’; and

20 (3) by inserting before the comma at the end

21 the following: ‘‘, or (cc) who are under 21 years of

22 age and with respect to whom supplemental security

23 income benefits would be paid under title XVI but

24 for section 1611(c)(7)’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 subsection (a) apply to medical assistance for items and

3 services furnished on or after October 1, 2000, except that

4 a State may elect to apply such amendments to items and

5 services furnished on or after any date after the date of

6 the enactment of this Act and before October 1, 2000.

Æ