I

106TH CONGRESS

1ST SESSION H. R. 1070

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

for certain women screened and found to have breast or cervical cancer

under a federally funded screening program.

IN THE HOUSE OF REPRESENTATIVES

MARCH 11, 1999

Mr. LAZIO (for himself, Ms. ESHOO, Ms. ROS-LEHTINEN, Mrs. CAPPS, Mrs.

MORELLA, Mrs. KELLY, Mr. BROWN of Ohio, Mr. GEORGE MILLER of

California, Mr. HORN, Mr. DIXON, Ms. PELOSI, Mr. LATOURETTE, Mr.

WAXMAN, Mr. SERRANO, Mr. GILMAN, Mr. MALONEY of Connecticut, Mr.

MEEHAN, Mr. WELDON of Pennsylvania, Mr. UNDERWOOD, Mr. SHOWS,

Mr. ABERCROMBIE, Mr. MCHUGH, Mr. ETHERIDGE, Mr. SANDERS, Mrs.

CLAYTON, Mr. WALSH, Mr. MCGOVERN, Mr. MCNULTY, Mr. FROST, Mr.

NEY, Mr. OLVER, Ms. MILLENDER-MCDONALD, Mr. CROWLEY, Mr.

SUNUNU, Mr. CLEMENT, Mr. STARK, Ms. CARSON, Mr. FOLEY, Mr.

COYNE, Mr. LANTOS, Mr. INSLEE, Mrs. WILSON, Mr. SHERMAN, Mr.

BALDACCI, Mr. BOEHLERT, Mr. LUTHER, Mr. HINOJOSA, Mr. DEFAZIO,

Mr. QUINN, Mr. PRICE of North Carolina, Mr. RANGEL, Mr. WEYGAND,

Mr. FORBES, Mr. MEEKS of New York, Mr. NADLER, Mr. BARRETT of

Wisconsin, Ms. WOOLSEY, Mr. KUCINICH, Mr. KING, Ms. SLAUGHTER,

Mrs. TAUSCHER, Mr. BILBRAY, Mr. THOMPSON of Mississippi, Mr. HINCHEY, Mr. KLECZKA, Mr. PAYNE, Mr. WYNN, Mr. JEFFERSON, Mr.

SMITH of New Jersey, Mr. MASCARA, Mr. LOBIONDO, Mr. OBERSTAR,

Mr. LEACH, Mr. RUSH, Mr. MATSUI, Mr. DINGELL, Mrs. EMERSON, Mr.

FILNER, Mrs. MYRICK, and Ms. LOFGREN) 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

medical assistance for certain women screened and found
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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. OPTIONAL MEDICAID COVERAGE OF CERTAIN

4 BREAST OR CERVICAL CANCER PATIENTS.

5 (a) COVERAGE AS OPTIONAL CATEGORICALLY

6 NEEDY GROUP.—

7 (1) IN GENERAL.—Section 1902(a)(10)(A)(ii)

8 of the Social Security Act (42 U.S.C.

9 1396a(a)(10)(A)(ii)) is amended—

10 (A) in subclause (XIII), by striking ‘‘or’’

11 at the end;

12 (B) in subclause (XIV), by adding ‘‘or’’ at

13 the end; and

14 (C) by adding at the end the following:

15 ‘‘(XV) who are described in sub16 section (aa) (relating to certain breast

17 or cervical cancer patients);’’.

18 (2) GROUP DESCRIBED.—Section 1902 of the

19 Social Security Act (42 U.S.C. 1396a) is amended

20 by adding at the end the following:

21 ‘‘(aa) Individuals described in this paragraph are in22 dividuals who—

23 ‘‘(1) are not described in subsection

24 (a)(10)(A)(i);
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1 ‘‘(2) have not attained age 65;

2 ‘‘(3) have been screened for breast and cervical

3 cancer under the Centers for Disease Control and

4 Prevention breast and cervical cancer early detection

5 program established under title XV of the Public

6 Health Service Act (42 U.S.C. 300k et seq.) in ac7 cordance with the requirements of section 1504 of

8 that Act (42 U.S.C. 300n) and need treatment for

9 breast or cervical cancer; and

10 ‘‘(4) are not otherwise covered under creditable

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

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

13 (3) LIMITATION ON BENEFITS.—Section

14 1902(a)(10) of the Social Security Act (42 U.S.C.

15 1396a(a)(10)) is amended in the matter following

16 subparagraph (F)—

17 (A) by striking ‘‘and (XIII)’’ and inserting

18 ‘‘(XIII)’’; and

19 (B) by inserting ‘‘, and (XIV) the medical

20 assistance made available to an individual de21 scribed in subsection (aa) who is eligible for

22 medical assistance only because of subpara23 graph (A)(10)(ii)(XV) shall be limited to medi24 cal assistance provided during the period in
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1 which such an individual requires treatment for

2 breast or cervical cancer’’ before the semicolon.

3 (4) CONFORMING AMENDMENTS.—Section

4 1905(a) of the Social Security Act (42 U.S.C.

5 1396d(a)) is amended in the matter preceding para6 graph (1)—

7 (A) in clause (x), by striking ‘‘or’’ at the

8 end;

9 (B) in clause (xi), by adding ‘‘or’’ at the

10 end; and

11 (C) by inserting after clause (xi) the fol12 lowing:

13 ‘‘(xii) individuals described in section

14 1902(aa),’’.

15 (b) PRESUMPTIVE ELIGIBILITY.—

16 (1) IN GENERAL.—Title XIX of the Social Se17 curity Act (42 U.S.C. 1396 et seq.) is amended by

18 inserting after section 1920A the following:

19 ‘‘PRESUMPTIVE ELIGIBILITY FOR CERTAIN BREAST OR

20 CERVICAL CANCER PATIENTS

21 ‘‘SEC. 1920B. (a) STATE OPTION.—A State plan ap22 proved under section 1902 may provide for making medi23 cal assistance available to an individual described in sec24 tion 1902(aa) (relating to certain breast or cervical cancer

25 patients) during a presumptive eligibility period.

26 ‘‘(b) DEFINITIONS.—For purposes of this section:
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1 ‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The

2 term ‘presumptive eligibility period’ means, with re3 spect to an individual described in subsection (a),

4 the period that—

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

6 qualified entity determines, on the basis of pre7 liminary information, that the individual is de8 scribed in section 1902(aa); and

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

10 of—

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

12 is made with respect to the eligibility of

13 such individual for services under the State

14 plan; or

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

16 who does not file an application by the last

17 day of the month following the month dur18 ing which the entity makes the determina19 tion referred to in subparagraph (A), such

20 last day.

21 ‘‘(2) QUALIFIED ENTITY.—

22 ‘‘(A) IN GENERAL.—Subject to subpara23 graph (B), the term ‘qualified entity’ means

24 any entity that—
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1 ‘‘(i) is eligible for payments under a

2 State plan approved under this title; 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 under a State plan shall—

6 ‘‘(A) notify the State agency of the deter7 mination within 5 working days after the date

8 on which determination is made; and

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

10 the determination is made that an application

11 for medical assistance under the State plan is

12 required to be made by not later than the last

13 day of the month following the month during

14 which the determination is made.

15 ‘‘(3) APPLICATION FOR MEDICAL ASSIST16 ANCE.—In the case of an individual described in

17 subsection (a) who is determined by a qualified en18 tity to be presumptively eligible for medical assist19 ance under a State plan, the individual shall apply

20 for medical assistance under such plan by not later

21 than the last day of the month following the month

22 during which the determination is made.

23 ‘‘(d) PAYMENT.—Notwithstanding any other provi24 sion of this title, medical assistance that—
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1 ‘‘(1) is furnished to an individual described in

2 subsection (a)—

3 ‘‘(A) during a presumptive eligibility pe4 riod;

5 ‘‘(B) by a entity that is eligible for pay6 ments under the State plan; and

7 ‘‘(2) is included in the care and services covered

8 by the State plan;

9 shall be treated as medical assistance provided by such

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

11 (2) CONFORMING AMENDMENTS.—

12 (A) Section 1902(a)(47) of the Social Se13 curity Act (42 U.S.C. 1396a(a)(47)) is amend14 ed by inserting before the semicolon at the end

15 the following: ‘‘and provide for making medical

16 assistance available to individuals described in

17 subsection (a) of section 1920B during a pre18 sumptive eligibility period in accordance with

19 such section’’.

20 (B) Section 1903(u)(1)(D)(v) of such Act

21 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended—

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

23 ‘‘, for’’; and

24 (ii) by inserting before the period the

25 following: ‘‘, or for medical assistance pro-
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1 vided to an individual described in sub2 section (a) of section 1920B during a pre3 sumptive eligibility period under such sec4 tion’’.

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

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

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

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

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

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

11 sums expended during such quarter which are at12 tributable to the offering, arranging, and furnishing

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

14 cancer-related treatment services; plus’’.

15 (d) EFFECTIVE DATE.—The amendments made by

16 this section apply to medical assistance furnished on or

17 after October 1, 1999, without regard to whether final

18 regulations to carry out such amendments have been pro19 mulgated by such date.

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