II

Calendar No. 641

106TH CONGRESS

2D SESSION S. 662

[Report No. 106–323]

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 SENATE OF THE UNITED STATES

MARCH 18, 1999

Mr. CHAFEE (for himself, Ms. MIKULSKI, Mr. MOYNIHAN, Ms. SNOWE, Mr.

SMITH of Oregon, Mr. HARKIN, Mr. COCHRAN, Mr. DURBIN, Mrs. MURRAY, Mr. LEAHY, Mr. ROCKEFELLER, Mr. LIEBERMAN, Mr. LAUTENBERG, Mrs. FEINSTEIN, Mr. BINGAMAN, Mr. SARBANES, Mr. HOLLINGS,

Mr. WELLSTONE, Mr. CLELAND, Mr. KENNEDY, Mr. JOHNSON, Mr.

ROBB, Mrs. BOXER, Mr. REID, Mr. KERREY, Ms. COLLINS, Mr. CONRAD,

Mr. BAYH, Mr. INOUYE, Mr. TORRICELLI, Mr. REED, Mr. DODD, Mr.

AKAKA, Mr. KERRY, Mr. DORGAN, Mrs. LINCOLN, Mr. MURKOWSKI, Mr.

SCHUMER, Mr. BOND, Mr. GRAHAM, Mr. GRASSLEY, Mr. JEFFORDS, Mr.

BAUCUS, Ms. LANDRIEU, Mr. EDWARDS, Mr. DASCHLE, Mr. BRYAN, Mr.

BYRD, Mr. BREAUX, Mr. HAGEL, Mr. LEVIN, Mr. KOHL, Mr. SPECTER,

Mr. WYDEN, Mr. ASHCROFT, Mr. L. CHAFEE, Mr. GRAMS, Mr. HATCH,

Mr. WARNER, Mr. ABRAHAM, Mr. BENNETT, Mrs. HUTCHISON, Mr.

CRAPO, Mr. MCCAIN, Mr. HELMS, Mr. ALLARD, Mr. STEVENS, Mr.

LUGAR, Mr. SMITH of New Hampshire, Mr. BIDEN, Mr. FRIST, Mr. GORTON, and Mr. DEWINE) introduced the following bill; which was read

twice and referred to the Committee on Finance

JUNE 27, 2000

Reported by Mr. ROTH with an amendment
2

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[Strike out all after the enacting clause and insert the part printed in italic]

A BILL

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.

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);’’.
3

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

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

3 by adding at the end the following:

4 ‘‘(aa) Individuals described in this paragraph are in5 dividuals who—

6 ‘‘(1) are not described in subsection

7 (a)(10)(A)(i);

8 ‘‘(2) have not attained age 65;

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

10 cancer under the Centers for Disease Control and

11 Prevention breast and cervical cancer early detection

12 program established under title XV of the Public

13 Health Service Act (42 U.S.C. 300k et seq.) in ac14 cordance with the requirements of section 1504 of

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

16 breast or cervical cancer; and

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

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

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

20 (3) LIMITATION ON BENEFITS.—Section

21 1902(a)(10) of the Social Security Act (42 U.S.C.

22 1396a(a)(10)) is amended in the matter following

23 subparagraph (F)—

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

25 ‘‘(XIII)’’; and
4

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

2 assistance made available to an individual de3 scribed in subsection (aa) who is eligible for

4 medical assistance only because of subpara5 graph (A)(ii)(XV) shall be limited to medical

6 assistance provided during the period in which

7 such an individual requires treatment for breast

8 or cervical cancer’’ before the semicolon.

9 (4) CONFORMING AMENDMENTS.—Section

10 1905(a) of the Social Security Act (42 U.S.C.

11 1396d(a)) is amended in the matter preceding para12 graph (1)—

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

14 end;

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

16 end; and

17 (C) by inserting after clause (xi) the fol18 lowing:

19 ‘‘(xii) individuals described in section

20 1902(aa),’’.

21 (b) PRESUMPTIVE ELIGIBILITY.—

22 (1) IN GENERAL.—Title XIX of the Social Se23 curity Act (42 U.S.C. 1396 et seq.) is amended by

24 inserting after section 1920A the following:
5

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1 ‘‘PRESUMPTIVE ELIGIBILITY FOR CERTAIN BREAST OR

2 CERVICAL CANCER PATIENTS

3 ‘‘SEC. 1920B. (a) STATE OPTION.—A State plan ap4 proved under section 1902 may provide for making med5 ical assistance available to an individual described in sec6 tion 1902(aa) (relating to certain breast or cervical cancer

7 patients) during a presumptive eligibility period.

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

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

10 term ‘presumptive eligibility period’ means, with re11 spect to an individual described in subsection (a),

12 the period that—

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

14 qualified entity determines, on the basis of pre15 liminary information, that the individual is de16 scribed in section 1902(aa); and

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

18 of—

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

20 is made with respect to the eligibility of

21 such individual for services under the State

22 plan; or

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

24 who does not file an application by the last

25 day of the month following the month dur-
6

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1 ing which the entity makes the determina2 tion referred to in subparagraph (A), such

3 last day.

4 ‘‘(2) QUALIFIED ENTITY.—

5 ‘‘(A) IN GENERAL.—Subject to subpara6 graph (B), the term ‘qualified entity’ means

7 any entity that—

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

9 State plan approved under this title; and

10 ‘‘(ii) is determined by the State agen11 cy to be capable of making determinations

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

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

14 issue regulations further limiting those entities

15 that may become qualified entities in order to

16 prevent fraud and abuse and for other reasons.

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

18 in this paragraph shall be construed as pre19 venting a State from limiting the classes of en20 tities that may become qualified entities, con21 sistent with any limitations imposed under sub22 paragraph (B).

23 ‘‘(c) ADMINISTRATION.—

24 ‘‘(1) IN GENERAL.—The State agency shall pro25 vide qualified entities with—
7

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

2 application to be made by an individual de3 scribed in subsection (a) for medical assistance

4 under the State plan; and

5 ‘‘(B) information on how to assist such in6 dividuals in completing and filing such forms.

7 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali8 fied entity that determines under subsection

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

10 (a) is presumptively eligible for medical assistance

11 under a State plan shall—

12 ‘‘(A) notify the State agency of the deter13 mination within 5 working days after the date

14 on which determination is made; and

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

16 the determination is made that an application

17 for medical assistance under the State plan is

18 required to be made by not later than the last

19 day of the month following the month during

20 which the determination is made.

21 ‘‘(3) APPLICATION FOR MEDICAL ASSIST22 ANCE.—In the case of an individual described in

23 subsection (a) who is determined by a qualified enti24 ty to be presumptively eligible for medical assistance

25 under a State plan, the individual shall apply for
8

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1 medical assistance under such plan by not later than

2 the last day of the month following the month dur3 ing which the determination is made.

4 ‘‘(d) PAYMENT.—Notwithstanding any other provi5 sion of this title, medical assistance that—

6 ‘‘(1) is furnished to an individual described in

7 subsection (a)—

8 ‘‘(A) during a presumptive eligibility pe9 riod;

10 ‘‘(B) by a entity that is eligible for pay11 ments under the State plan; and

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

13 by the State plan;

14 shall be treated as medical assistance provided by such

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

16 (2) CONFORMING AMENDMENTS.—

17 (A) Section 1902(a)(47) of the Social Se18 curity Act (42 U.S.C. 1396a(a)(47)) is amend19 ed by inserting before the semicolon at the end

20 the following: ‘‘and provide for making medical

21 assistance available to individuals described in

22 subsection (a) of section 1920B during a pre23 sumptive eligibility period in accordance with

24 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 pro7 vided to an individual described in sub8 section (a) of section 1920B during a pre9 sumptive eligibility period under such sec10 tion’’.

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

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

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

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

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

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

17 sums expended during such quarter which are at18 tributable to the offering, arranging, and furnishing

19 (directly or on a contract basis) of medical assist20 ance to an individual described in section 1902(aa);

21 plus’’.

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

23 this section apply to medical assistance furnished on or

24 after October 1, 1999, without regard to whether final
10

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1 regulations to carry out such amendments have been pro2 mulgated by such date.

3 SECTION 1. SHORT TITLE.

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

5 Cancer Prevention and Treatment Act of 2000’’.

6 SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN

7 BREAST OR CERVICAL CANCER PATIENTS.

8 (a) COVERAGE AS OPTIONAL CATEGORICALLY NEEDY

9 GROUP.—

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

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

12 1396a(a)(10)(A)(ii)) is amended—

13 (A) in subclause (XVI), by striking ‘‘or’’ at

14 the end;

15 (B) in subclause (XVII), by adding ‘‘or’’ at

16 the end; and

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

18 ‘‘(XVIII) who are described in

19 subsection (aa) (relating to certain

20 breast or cervical cancer patients);’’.

21 (2) GROUP DESCRIBED.—Section 1902 of the So22 cial Security Act (42 U.S.C. 1396a) is amended by

23 adding at the end the following:

24 ‘‘(aa) Individuals described in this subsection are indi25 viduals who—
11

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1 ‘‘(1) are not described in subsection

2 (a)(10)(A)(i);

3 ‘‘(2) have not attained age 65;

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

5 cancer under the Centers for Disease Control and Pre6 vention breast and cervical cancer early detection

7 program established under title XV of the Public

8 Health Service Act (42 U.S.C. 300k et seq.) in accord9 ance with the requirements of section 1504 of that Act

10 (42 U.S.C. 300n) and need treatment for breast or

11 cervical cancer; and

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

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

14 Health Service Act (42 U.S.C. 300gg(c)).’’.

15 (3) LIMITATION ON BENEFITS.—Section

16 1902(a)(10) of the Social Security Act (42 U.S.C.

17 1396a(a)(10)) is amended in the matter following

18 subparagraph (G)—

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

20 ‘‘(XIII)’’; and

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

22 assistance made available to an individual de23 scribed in subsection (aa) who is eligible for

24 medical assistance only because of subparagraph

25 (A)(10)(ii)(XVIII) shall be limited to medical as-
12

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1 sistance provided during the period in which

2 such an individual requires treatment for breast

3 or cervical cancer’’ before the semicolon.

4 (4) CONFORMING AMENDMENTS.—Section

5 1905(a) of the Social Security Act (42 U.S.C.

6 1396d(a)) is amended in the matter preceding para7 graph (1)—

8 (A) in clause (xi), by striking ‘‘or’’ at the

9 end;

10 (B) in clause (xii), by adding ‘‘or’’ at the

11 end; and

12 (C) by inserting after clause (xii) the fol13 lowing:

14 ‘‘(xiii) individuals described in section

15 1902(aa),’’.

16 (b) PRESUMPTIVE ELIGIBILITY.—

17 (1) IN GENERAL.—Title XIX of the Social Secu18 rity Act (42 U.S.C. 1396 et seq.) is amended by in19 serting after section 1920A the following:

20 ‘‘PRESUMPTIVE ELIGIBILITY FOR CERTAIN BREAST OR

21 CERVICAL CANCER PATIENTS

22 ‘‘SEC. 1920B. (a) STATE OPTION.—A State plan ap23 proved under section 1902 may provide for making medical

24 assistance available to an individual described in section

25 1902(aa) (relating to certain breast or cervical cancer pa26 tients) during a presumptive eligibility period.
13

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

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

3 term ‘presumptive eligibility period’ means, with re4 spect to an individual described in subsection (a), the

5 period that—

6 ‘‘(A) begins with the date on which a quali7 fied entity determines, on the basis of prelimi8 nary information, that the individual is de9 scribed in section 1902(aa); and

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

11 of—

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

13 is made with respect to the eligibility of

14 such individual for services under the State

15 plan; or

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

17 who does not file an application by the last

18 day of the month following the month dur19 ing which the entity makes the determina20 tion referred to in subparagraph (A), such

21 last day.

22 ‘‘(2) QUALIFIED ENTITY.—

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graph (B), the term ‘qualified entity’ means any

25 entity that—
14

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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 agency

4 to be capable of making determinations of

5 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 in

11 this paragraph shall be construed as preventing

12 a State from limiting the classes of entities that

13 may become qualified entities, consistent with

14 any limitations imposed under subparagraph

15 (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 ap20 plication to be made by an individual described

21 in subsection (a) for medical assistance under

22 the State plan; and

23 ‘‘(B) information on how to assist such in24 dividuals in completing and filing such forms.
15

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1 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali2 fied entity that determines under subsection (b)(1)(A)

3 that an individual described in subsection (a) is pre4 sumptively eligible for medical assistance under a

5 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 the

10 determination is made that an application for

11 medical assistance under the State plan is re12 quired to be made by not later than the last day

13 of the month following the month during which

14 the determination is made.

15 ‘‘(3) APPLICATION FOR MEDICAL ASSISTANCE.—

16 In the case of an individual described in subsection

17 (a) who is determined by a qualified entity to be pre18 sumptively eligible for medical assistance under a

19 State plan, the individual shall apply for medical as20 sistance under such plan by not later than the last

21 day of the month following the month during which

22 the determination is made.

23 ‘‘(d) PAYMENT.—Notwithstanding any other provision

24 of this title, medical assistance that—
16

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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 plan

10 for purposes of clause (4) of the first sentence of section

11 1905(b).’’.

12 (2) CONFORMING AMENDMENTS.—

13 (A) Section 1902(a)(47) of the Social Secu14 rity Act (42 U.S.C. 1396a(a)(47)) is amended by

15 inserting before the semicolon at the end the fol16 lowing: ‘‘and provide for making medical assist17 ance available to individuals described in sub18 section (a) of section 1920B during a presump19 tive eligibility period in accordance with such

20 section’’.

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

22 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended—

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

24 ‘‘, for’’; and
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1 (ii) by inserting before the period the

2 following: ‘‘, or for medical assistance pro3 vided to an individual described in sub4 section (a) of section 1920B during a pre5 sumptive eligibility period under such sec6 tion’’.

7 (c) ENHANCED MATCH.—The first sentence of section

8 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is

9 amended—

10 (1) by striking ‘‘and’’ before ‘‘(3)’’; and

11 (2) by inserting before the period at the end the

12 following: ‘‘, and (4) the Federal medical assistance

13 percentage shall be equal to the enhanced FMAP de14 scribed in section 2105(b) with respect to medical as15 sistance provided to individuals who are eligible for

16 such assistance only on the basis of section

17 1902(a)(10)(A)(ii)(XVIII)’’.

18 (d) EFFECTIVE DATE.—The amendments made by this

19 section apply to medical assistance for items and services

20 furnished on or after October 1, 2000, without regard to

21 whether final regulations to carry out such amendments

22 have been promulgated by such date.
Calendar No. 641

106TH CONGRESS

2D SESSION S. 662

[Report No. 106–323]

A BILL

To amend title XIX of the Social Security Act to

provide medical assistance for certain womenscreened and found to have breast or cervicalcancer under a federally funded screening program.

JUNE 27, 2000

Reported with an amendment