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106TH CONGRESS

1ST SESSION S. 662

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, Mr. COLLINS, Mr. CONRAD,

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

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 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,
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1 SECTION 1. OPTIONAL MEDICAID COVERAGE OF CERTAIN

2 BREAST OR CERVICAL CANCER PATIENTS.

3 (a) COVERAGE AS OPTIONAL CATEGORICALLY

4 NEEDY GROUP.—

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

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

7 1396a(a)(10)(A)(ii)) is amended—

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

9 at the end;

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

11 the end; and

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

13 ‘‘(XV) who are described in sub14 section (aa) (relating to certain breast

15 or cervical cancer patients);’’.

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

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

18 by adding at the end the following:

19 ‘‘(aa) Individuals described in this paragraph are in20 dividuals who—

21 ‘‘(1) are not described in subsection

22 (a)(10)(A)(i);

23 ‘‘(2) have not attained age 65;

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

25 cancer under the Centers for Disease Control and

26 Prevention breast and cervical cancer early detection
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1 program established under title XV of the Public

2 Health Service Act (42 U.S.C. 300k et seq.) in ac3 cordance with the requirements of section 1504 of

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

5 breast or cervical cancer; and

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

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

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

9 (3) LIMITATION ON BENEFITS.—Section

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

11 1396a(a)(10)) is amended in the matter following

12 subparagraph (F)—

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

14 ‘‘(XIII)’’; and

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

16 assistance made available to an individual de17 scribed in subsection (aa) who is eligible for

18 medical assistance only because of subpara19 graph (A)(ii)(XV) shall be limited to medical

20 assistance provided during the period in which

21 such an individual requires treatment for breast

22 or cervical cancer’’ before the semicolon.

23 (4) CONFORMING AMENDMENTS.—Section

24 1905(a) of the Social Security Act (42 U.S.C.
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1 1396d(a)) is amended in the matter preceding para2 graph (1)—

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

4 end;

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

6 end; and

7 (C) by inserting after clause (xi) the fol8 lowing:

9 ‘‘(xii) individuals described in section

10 1902(aa),’’.

11 (b) 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 med19 ical assistance available to an individual described in sec20 tion 1902(aa) (relating to certain breast or cervical cancer

21 patients) during a presumptive eligibility period.

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

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

24 term ‘presumptive eligibility period’ means, with re25 spect to an individual described in subsection (a),

26 the period that—
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1 ‘‘(A) begins with the date on which a

2 qualified entity determines, on the basis of pre3 liminary information, that the individual is de4 scribed in section 1902(aa); and

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

6 of—

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

8 is made with respect to the eligibility of

9 such individual for services under the State

10 plan; or

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

12 who does not file an application by the last

13 day of the month following the month dur14 ing which the entity makes the determina15 tion referred to in subparagraph (A), such

16 last day.

17 ‘‘(2) QUALIFIED ENTITY.—

18 ‘‘(A) IN GENERAL.—Subject to subpara19 graph (B), the term ‘qualified entity’ means

20 any entity that—

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

22 State plan approved under this title; and

23 ‘‘(ii) is determined by the State agen24 cy to be capable of making determinations

25 of the type described in paragraph (1)(A).
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1 ‘‘(B) REGULATIONS.—The Secretary may

2 issue regulations further limiting those entities

3 that may become qualified entities in order to

4 prevent fraud and abuse and for other reasons.

5 ‘‘(C) RULE OF CONSTRUCTION.—Nothing

6 in this paragraph shall be construed as pre7 venting a State from limiting the classes of en8 tities that may become qualified entities, con9 sistent with any limitations imposed under sub10 paragraph (B).

11 ‘‘(c) ADMINISTRATION.—

12 ‘‘(1) IN GENERAL.—The State agency shall pro13 vide qualified entities with—

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

15 application to be made by an individual de16 scribed in subsection (a) for medical assistance

17 under the State plan; and

18 ‘‘(B) information on how to assist such in19 dividuals in completing and filing such forms.

20 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali21 fied entity that determines under subsection

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

23 (a) is presumptively eligible for medical assistance

24 under a State plan shall—
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1 ‘‘(A) notify the State agency of the deter2 mination within 5 working days after the date

3 on which determination is made; and

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

5 the determination is made that an application

6 for medical assistance under the State plan is

7 required to be made by not later than the last

8 day of the month following the month during

9 which the determination is made.

10 ‘‘(3) APPLICATION FOR MEDICAL ASSIST11 ANCE.—In the case of an individual described in

12 subsection (a) who is determined by a qualified enti13 ty to be presumptively eligible for medical assistance

14 under a State plan, the individual shall apply for

15 medical assistance under such plan by not later than

16 the last day of the month following the month dur17 ing which the determination is made.

18 ‘‘(d) PAYMENT.—Notwithstanding any other provi19 sion of this title, medical assistance that—

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

21 subsection (a)—

22 ‘‘(A) during a presumptive eligibility pe23 riod;

24 ‘‘(B) by a entity that is eligible for pay25 ments under the State plan; and
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1 ‘‘(2) is included in the care and services covered

2 by the State plan;

3 shall be treated as medical assistance provided by such

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

5 (2) CONFORMING AMENDMENTS.—

6 (A) Section 1902(a)(47) of the Social Se7 curity Act (42 U.S.C. 1396a(a)(47)) is amend8 ed by inserting before the semicolon at the end

9 the following: ‘‘and provide for making medical

10 assistance available to individuals described in

11 subsection (a) of section 1920B during a pre12 sumptive eligibility period in accordance with

13 such section’’.

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

15 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended—

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

17 ‘‘, for’’; and

18 (ii) by inserting before the period the

19 following: ‘‘, or for medical assistance pro20 vided to an individual described in sub21 section (a) of section 1920B during a pre22 sumptive eligibility period under such sec23 tion’’.

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

25 Social Security Act (42 U.S.C. 1396b(a)(5)) is amended—
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1 (1) by striking ‘‘an’’ and inserting ‘‘(A) an’’;

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

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

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

5 sums expended during such quarter which are at6 tributable to the offering, arranging, and furnishing

7 (directly or on a contract basis) of medical assist8 ance to an individual described in section 1902(aa);

9 plus’’.

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

11 this section apply to medical assistance furnished on or

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

13 regulations to carry out such amendments have been pro14 mulgated by such date.

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