II

105TH CONGRESS

2D SESSION S. 1858

To amend the Social Security Act to provide individuals with disabilities

with incentives to become economically self-sufficient.

IN THE SENATE OF THE UNITED STATES

MARCH 25, 1998

Mr. JEFFORDS (for himself, Mr. KENNEDY, and Mr. HARKIN) introduced the

following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend the Social Security Act to provide individuals

with disabilities with incentives to become economically

self-sufficient.

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 ‘‘Work Incentives Improvement Act of 1998’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings and purposes.

TITLE I—ESTABLISHMENT OF OPTIONS PROGRAM

Sec. 101. OPTIONS program for working individuals with disabilities.
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Sec. 102. Work incentive counseling and assistance program.

TITLE II—EXPANDED AVAILABILITY OF HEALTH CARE SERVICES

Sec. 201. State work options program under medicaid.

Sec. 202. Extension of medicare benefits for SSDI OPTIONS program participants.

TITLE III—DEMONSTRATION PROJECTS AND OUTREACH

Sec. 301. Demonstration projects.

Sec. 302. Information and outreach regarding work opportunities for individuals with a disability.

TITLE IV—MISCELLANEOUS

Sec. 401. Report and recommendations to Congress.

Sec. 402. Effective dates.

1 SEC. 2. FINDINGS AND PURPOSES.

2 (a) FINDINGS.—Congress makes the following find3 ings:

4 (1) Health care is important to all Americans.

5 (2) Health care is particularly important to in6 dividuals with disabilities and special health care

7 needs who often cannot afford the insurance avail8 able to them through the private market, are unin9 surable by the plans available in the private sector,

10 and are at great risk of incurring very high and dev11 astating health care costs.

12 (3) Americans with severe disabilities and spe13 cial health care needs often are unable to obtain in14 surance that provides them with the necessary serv15 ices, such as personal assistance services, prescrip16 tion drugs, and durable medical equipment, that
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1 they need to maintain their employment and inde2 pendence.

3 (4) For individuals with disabilities, the fear of

4 losing health care and related services is one of the

5 greatest barriers keeping the individuals from maxi6 mizing their employment and earning potential.

7 (5) Social security disability insurance (DI)

8 beneficiaries and supplemental security income (SSI)

9 disability recipients risk losing medicare or medicaid

10 coverage that is linked to their cash benefits, a risk

11 that is an equal, or greater, work disincentive than

12 the loss of cash benefits associated with working.

(6) Currently, less than 1 13 ⁄2 of 1 percent of so14 cial security disability insurance and supplemental

15 security income beneficiaries cease to receive benefits

16 as a result of employment.

(7) If an additional 1 17 ⁄2 of 1 percent of the cur18 rent social security disability insurance (DI) and

19 supplemental security income (SSI) recipients were

20 to cease receiving benefits as a result of employ21 ment, the savings in cash assistance would total

22 $3,500,000,000 over the work life of the individuals.

23 (b) PURPOSES.—The purposes of this Act are as fol24 lows:
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1 (1) To provide health care services to individ2 uals with disabilities that will enable those individ3 uals to cease to receive social security disability in4 surance benefits and become employed and inde5 pendent.

6 (2) To provide States with the option of allow7 ing individuals with disabilities to purchase, through

8 medicaid and subject to a copayment requirement,

9 the personal assistance services and prescription

10 drugs that the private insurance available to such in11 dividuals does not provide.

12 (3) To provide individuals with disabilities with

13 the option of purchasing and maintaining medicare

14 coverage after returning to work.

15 TITLE I—ESTABLISHMENT OF

16 OPTIONS PROGRAM

17 SEC. 101. OPTIONS PROGRAM FOR WORKING INDIVIDUALS

18 WITH DISABILITIES.

19 (a) ESTABLISHMENT.—Title XI of the Social Secu20 rity Act (42 U.S.C. 1301 et seq.) is amended by adding

21 at the end the following:

22 ‘‘PART D—OPTIONS PROGRAM FOR WORKING

23 INDIVIDUALS WITH DISABILITIES

24 ‘‘DEFINITIONS

25 ‘‘SEC. 1181. In this part:
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1 ‘‘(1) COMMISSIONER.—The term ‘Commis2 sioner’ means the Commissioner of Social Security.

3 ‘‘(2) ELIGIBLE WORKING INDIVIDUAL WITH A

4 DISABILITY.—The term ‘eligible working individual

5 with a disability’ means an individual who, based on

6 a determination by the State, is found eligible for

7 personal assistance services or prescribed drugs

8 under section 1929A because without such services

9 or drugs the individual would be unable to perform

10 essential functions of the employment position that

11 the individual holds or desires, but does not include

12 any individual who is receiving—

13 ‘‘(A) disability benefits under title II; or

14 ‘‘(B) supplemental security income benefits

15 under title XVI.

16 ‘‘(3) SSDI OPTIONS PROGRAM PARTICI17 PANT.—The term ‘SSDI OPTIONS program partic18 ipant’ means an individual eligible for cash benefits

19 under title 223 on the basis of being disabled who

20 has elected to participate in the OPTIONS program

21 established under this part.

22 ‘‘(4) SUBSTANTIAL GAINFUL ACTIVITY.—The

23 term ‘substantial gainful activity’ has the meaning

24 given that term under section 223 with respect to an

25 individual who has been determined to be eligible for
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1 cash benefits under such section on the basis of

2 being disabled.

3 ‘‘OPPORTUNITY TO FULLY INTEGRATE THROUGH

4 OCCUPATIONS

5 ‘‘SEC. 1182. (a) ESTABLISHMENT OF OPTIONS

6 PROGRAM.—

7 ‘‘(1) IN GENERAL.—The Commissioner, in con8 sultation with the Secretary, shall establish a pro9 gram, to be known as the OPTIONS program,

10 under which—

11 ‘‘(A) an eligible working individual with a

12 disability and a SSDI OPTIONS program par13 ticipant—

14 ‘‘(i) shall receive, without being sub15 jected to a waiting period, work incentive

16 services under title XIX to the extent the

17 State in which the individual or participant

18 resides makes such services available in ac19 cordance with section 1929A; and

20 ‘‘(ii) shall receive work counseling and

21 assistance, as provided under section 1183;

22 and

23 ‘‘(B) a SSDI OPTIONS program partici24 pant—

25 ‘‘(i) shall be provided, after having

26 been entitled to receive cash benefits under
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1 section 223 for at least 24 months (or hav2 ing participated in the OPTIONS program

3 for at least such period), with the oppor4 tunity to purchase hospital insurance bene5 fits under part A of title XVIII and sup6 plementary medical insurance benefits

7 under part B of such title, in accordance

8 with section 1818B, for as long as the in9 dividual participates in the OPTIONS pro10 gram; and

11 ‘‘(ii) shall choose—

12 ‘‘(I) to waive cash benefits under

13 section 223 and acquire average

14 monthly earnings from substantial

15 gainful activity in excess of the

16 amount designated to represent such

17 activity by the Commissioner; or

18 ‘‘(II) if at the time the individual

19 first elects to participate in the OP20 TIONS program, the individual has

21 received cash benefits under section

22 223 for at least 24 months, to not

23 waive cash benefits under section 223,

24 and to continue to be subject to the

25 limitation imposed by the Commis-
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1 sioner for other disability beneficiaries

2 under section 223 with respect to av3 erage monthly earnings from substan4 tial gainful activity.

5 ‘‘(2) WAIVER OF CASH BENEFITS HAS NO EF6 FECT ON BENEFITS FOR DEPENDENTS AND SUR7 VIVORS.—A waiver of cash benefits under paragraph

8 (1)(B)(ii)(I) by an individual shall have no effect on

9 the eligibility for, or entitlement to, benefits of a de10 pendent or survivor of such individual under section

11 202.

12 ‘‘(b) OPTIONS FORM.—The Commissioner shall

13 prepare and disseminate a form that shall be entitled ‘Op14 portunity to Fully Integrate Through Occupations Pro15 gram’. The form shall be used by an individual to elect

16 to participate in the OPTIONS program.

17 ‘‘(c) TIMING.—An individual may elect to participate

18 in the OPTIONS program at any time.

19 ‘‘(d) CONTINUING DISABILITY AND OTHER WORK20 RELATED REVIEWS.—

21 ‘‘(1) REGULAR REVIEWS.—A SSDI OPTIONS

22 program participant shall continue to be subject to

23 continuing disability reviews on the same regularly

24 scheduled basis that would occur if the individual
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1 had not chosen to participate in the OPTIONS pro2 gram.

3 ‘‘(2) WORK ACTIVITY, OR THE CESSATION OF

4 WORK ACTIVITY, MAY NOT BE THE BASIS FOR A RE5 VIEW, A FINDING OF NO DISABILITY, OR A PRESUMP6 TION OF AN INABILITY TO WORK.—No continuing

7 disability review or any other work-related review

8 may be scheduled for a SSDI OPTIONS program

9 participant solely as a result of work activity en10 gaged in by the individual while participating in the

11 OPTIONS program, no work activity engaged in by

12 the individual while participating in the program

13 may be used as evidence that the individual is no

14 longer disabled, and no cessation of work activity by

15 the individual while participating in the program

16 may give rise to a presumption that the individual

17 is unable to engage in work.

18 ‘‘(e) RULES APPLICABLE TO SSDI OPTIONS PRO19 GRAM PARTICIPANTS WHO CHOOSE TO RETAIN CASH

20 DISABILITY BENEFITS.—

21 ‘‘(1) DETERMINATION OF IMPAIRMENT-RELAT22 ED WORK EXPENSES.—In the case of a SSDI OP23 TIONS program participant who chooses to continue

24 to receive cash benefits under section 223, the deter25 mination of the participant’s impairment-related
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1 work expenses for purposes of determining the ex2 tent to which the participant has engaged in sub3 stantial gainful activity shall include expenditures in4 curred by the participant for items and services re5 lated to the preparation for, and traveling to and

6 from, employment, including expenditures for dura7 ble medical equipment, as defined in section

8 1861(n), adapting a vehicle for the participant, and

9 orientation mobility services.

10 ‘‘(2) EXCLUSION OF COST OF A VEHICLE FROM

11 INCOME OF RURAL RESIDENTS.—

12 ‘‘(A) IN GENERAL.—In the case of a SSDI

13 OPTIONS program participant who chooses to

14 continue to receive cash benefits under section

15 223 and who resides in a rural area, the Com16 missioner shall exclude from the monthly deter17 mination of the participant’s income the cost of

18 obtaining a vehicle for the participant, subject

19 to such reasonable limits as the Commissioner

20 may prescribe.

21 ‘‘(B) ONE-TIME EXCLUSION.—The exclu22 sion authorized under subparagraph (A) may

23 only be made with respect to 1 vehicle per par24 ticipant.
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1 ‘‘(C) DEFINITION OF RURAL AREA.—For

2 purposes of subparagraph (A), the term ‘rural

3 area’ means any area that does not have rea4 sonably available and accessible public transpor5 tation, as determined by the Commissioner.

6 ‘‘(3) OVERPAYMENT OF BENEFITS.—Any erro7 neous overpayments of cash benefits to a SSDI OP8 TIONS program participant who chooses to continue

9 to receive cash benefits under section 223 that are

10 not the result of fraudulent or deceptive activity by,

11 or information from, the individual shall be retained

12 by the participant.

13 ‘‘(f) TERMINATION OF EMPLOYMENT.—If a SSDI

14 OPTIONS program participant terminates his or her em15 ployment, the participant—

16 ‘‘(1) shall no longer be considered a SSDI OP17 TIONS program participant for purposes of this

18 part, section 226(j), or section 1929A;

19 ‘‘(2) shall be presumed automatically eligible

20 for cash benefits under section 223 and hospital in21 surance benefits under section 226, and for supple22 mental security income benefits under title XVI and

23 medical assistance under title XIX (if applicable),

24 and any month in which the participant participated

25 in the OPTIONS program shall be included in the
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1 determination of the 24-month period required for

2 hospital insurance benefits under section

3 226(b)(2)(A); and

4 ‘‘(3) shall continue to be eligible for work incen5 tive services offered in accordance with section

6 1929A, only to the extent that the State where the

7 participant resides offers such services and the par8 ticipant otherwise qualifies for such services.

9 ‘‘(g) NO EFFECT ON ELIGIBILITY FOR TITLE XX

10 AND OTHER PROGRAMS.—Participation in the OPTIONS

11 program by an eligible working individual with a disability

12 or a SSDI OPTIONS program participant shall have no

13 effect (except to the extent that such participation is a

14 condition for eligibility for work incentive services under

15 section 1929A) on any benefits that the individual or par16 ticipant is eligible for, or provided under, title XX or any

17 other Federal or State program (other than the programs

18 under titles II and XVIII).

19 ‘‘RESERVED

20 ‘‘SEC. 1183. [Reserved].

21 ‘‘REGULATIONS

22 ‘‘SEC. 1184. Not later than 1 year after the date of

23 enactment of this part, the Commissioner, in consultation

24 with the Secretary, shall promulgate such final regula25 tions, including regulations related to ensuring program
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1 integrity, as are necessary to implement the OPTIONS

2 program established under this part.

3 ‘‘REPORTS

4 ‘‘SEC. 1185. The Commissioner, in consultation with

5 the Secretary, shall submit the following reports to the

6 appropriate committees of Congress:

7 ‘‘(1) Not later than 3 years after the date of

8 enactment of the OPTIONS program, a report on

9 the establishment of the program.

10 ‘‘(2) Not later than 5 years after such date, a

11 report on the progress of the OPTIONS program.

12 ‘‘(3) Not later than 7 years after such date, a

13 final report recommending whether the OPTIONS

14 program should be permanently authorized.

15 ‘‘APPROPRIATIONS

16 ‘‘SEC. 1186. (a) IN GENERAL.—Out of any funds in

17 the Treasury not otherwise appropriated, there are appro18 priated such sums as may be necessary to carry out the

19 OPTIONS program established under this part, other

20 than the work incentive counseling and assistance pro21 gram established under section 1183.

22 ‘‘(b) WORK INCENTIVE COUNSELING AND ASSIST23 ANCE PROGRAM.—The Commissioner shall use funds ap24 propriated and otherwise made available for programs

25 under titles II and XVI of this Act to carry out the work
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1 incentive counseling and assistance program established

2 under section 1183.

3 ‘‘SUNSET

4 ‘‘SEC. 1187. The OPTIONS program established

5 under this part shall terminate on the date that is 10

6 years after the date of enactment of this part.’’.

7 (b) CONFORMING AMENDMENTS.—

8 (1) EXTENDED PERIOD OF ELIGIBILITY.—Sec9 tion 223(a)(1) of the Social Security Act (42 U.S.C.

10 423(a)(1)) is amended by inserting after the second

11 sentence the following: ‘‘For purposes of subclause

12 (II) of the preceding sentence, the determination of

13 the 36-month period shall not include a month in

14 which the individual was a SSDI OPTIONS pro15 gram participant.’’.

16 (2) PERIOD OF TRIAL WORK.—The last sen17 tence of section 222(c)(3) of the Social Security Act

18 (42 U.S.C. 422(c)(3)) is amended by inserting be19 fore the period the following: ‘‘; and no such period

20 may begin in or include a month in which the indi21 vidual was a SSDI OPTIONS program participant’’.

22 (3) NONAPPLICATION OF ENTITLEMENT TO

23 HOSPITAL INSURANCE BENEFITS; CROSS-REF24 ERENCE.—Section 226 of the Social Security Act

25 (42 U.S.C. 426) is amended by adding at the end

26 the following:
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1 ‘‘NONAPPLICATION TO OPTIONS PARTICIPANTS; CROSS2 REFERENCE

3 ‘‘(j) Subsection (b) shall not apply to any individual

4 that would otherwise be entitled to hospital insurance ben5 efits under such subsection who is a SSDI OPTIONS pro6 gram participant, as defined in section 1181(3). For provi7 sions relating to the availability of health care benefits

8 under sections 1818B and 1929A for such individuals, and

9 to eligibility for work counseling and assistance, as pro10 vided in section 1183, see part D of title XI.’’.

11 (4) ADDITIONAL CROSS-REFERENCE.—Section

12 223 of the Social Security Act (42 U.S.C. 423 is

13 amended by adding at the end the following:

14 ‘‘OPTIONAL WAIVER OF BENEFITS

15 ‘‘(j) For provisions relating to the availability of

16 health care benefits under sections 1818B and 1929A for

17 individuals who participate in the OPTIONS program es18 tablished under part D of title XI, and to eligibility for

19 work counseling and assistance, as provided in section

20 1183, see part D of title XI.’’.

21 (5) HEADING OF TITLE XI.—Title XI of the So22 cial Security Act (42 U.S.C. 1301 et seq.) is amend23 ed in the title by striking ‘‘AND ADMINISTRA24 TIVE SIMPLIFICATION’’ and inserting ‘‘ADMIN25 ISTRATIVE SIMPLIFICATION, AND OPTIONS
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1 PROGRAM FOR WORKING INDIVIDUALS

2 WITH DISABILITIES’’.

3 SEC. 102. WORK INCENTIVE COUNSELING AND ASSISTANCE

4 PROGRAM.

5 Section 1183 of the Social Security Act (as added by

6 section 101(a)) is amended to read as follows:

7 ‘‘WORK INCENTIVE COUNSELING AND ASSISTANCE

8 PROGRAM

9 ‘‘SEC. 1183. (a) ESTABLISHMENT.—The Commis10 sioner shall establish a community-based work incentive

11 counseling and assistance program under which the Com12 missioner shall enter into agreements to provide counsel13 ing and assistance to eligible working individuals with a

14 disability and SSDI OPTIONS program participants. The

15 agreements authorized under the preceding sentence shall

16 be made with States and public and private agencies and

17 organizations (other than Social Security Administration

18 Field Offices) that the Commissioner determines have ex19 perience in providing rehabilitation services or independ20 ent living and social services to working individuals with

21 disabilities, and are qualified to provide counseling and as22 sistance in accordance with the requirements described in

23 subsection (b). The agreements may be made with any of

24 the following:

25 ‘‘(1) Vocational rehabilitation agencies.
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1 ‘‘(2) The State agency administering the State

2 program funded under part A of title IV.

3 ‘‘(3) The State agency administering the State

4 medicaid program under title XIX.

5 ‘‘(4) State employment training and placement

6 agencies.

7 ‘‘(5) Any other public or private agency or or8 ganization that the Commissioner determines satis9 fies the requirements of this section.

10 ‘‘(b) REQUIREMENTS.—

11 ‘‘(1) IN GENERAL.—Counselors for the program

12 established under this section shall—

13 ‘‘(A) assess the education and skills of an

14 eligible working individual with a disability or a

15 SSDI OPTIONS program participant, in co16 ordination and communication with the local

17 Social Security Administration Field Office for

18 the area in which such individual or participant

19 resides;

20 ‘‘(B) on the basis of the assessment con21 ducted under subparagraph (A), assist in the

22 identification of employment or vocational reha23 bilitation opportunities that may be available to

24 the individual or participant; and
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1 ‘‘(C) advise the individual or participant on

2 the adequacy of any health benefits coverage

3 that may be offered by an employer of the indi4 vidual or participant and the extent to which

5 other health benefits coverage may be available

6 to the individual or participant, including per7 sonal assistance services and prescription drugs

8 provided under section 1929A, if the State in

9 which the individual or participant resides opts

10 to provide such services.

11 ‘‘(2) COORDINATION WITH OTHER PRO12 GRAMS.—The program established under this section

13 shall be conducted in coordination with other public

14 and private programs that provide information and

15 assistance regarding rehabilitation services and inde16 pendent living supports and benefits counseling for

17 working individuals with disabilities.

18 ‘‘(3) OPTIONS TRAINING FOR SOCIAL SECURITY

19 ADMINISTRATION FIELD OFFICE WORK INCENTIVE

20 DESIGNEES.—The Commissioner shall provide train21 ing regarding the OPTIONS program for the em22 ployee in each Social Security Administration Field

23 Office that is designated to act as the work incentive

24 coordinator for that office.’’.
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1 TITLE II—EXPANDED AVAILABIL2 ITY OF HEALTH CARE SERV3 ICES

4 SEC. 201. STATE WORK OPTIONS PROGRAM UNDER MEDIC5 AID.

6 (a) STATE OPTION TO PROVIDE WORK INCENTIVE

7 SERVICES.—Title XIX of the Social Security Act (42

8 U.S.C. 1396 et seq.) is amended by inserting after section

9 1929 the following:

10 ‘‘STATE WORK OPTIONS PROGRAM

11 ‘‘SEC. 1929A. (a) DEFINITIONS.—In this section:

12 ‘‘(1) PERSONAL ASSISTANCE SERVICES.—The

13 term ‘personal assistance services’ means a range of

14 services, provided by 1 or more persons, designed to

15 assist an individual with a disability to perform daily

16 living activities on or off the job that the individual

17 would typically perform if the individual did not

18 have a disability. Such services shall be designed to

19 increase the individual’s control in life and ability to

20 perform everyday activities on or off the job.

21 ‘‘(2) ELIGIBLE WORKING INDIVIDUAL WITH A

22 DISABILITY.—The term ‘eligible working individual

23 with a disability’ means an individual who, based on

24 a determination by the State, is found eligible for

25 personal assistance services or prescribed drugs
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1 under this section because without such services or

2 drugs the individual would be unable to perform es3 sential functions of the employment position that the

4 individual holds or desires, but does not include any

5 individual who is receiving—

6 ‘‘(A) disability benefits under title II; or

7 ‘‘(B) supplemental security income benefits

8 under title XVI.

9 ‘‘(3) QUALIFIED ELIGIBLE WORKING INDIVID10 UAL WITH A DISABILITY.—The term ‘qualified eligi11 ble working individual with a disability’ means an in12 dividual who has attained age 18 but has not at13 tained age 65, and who—

14 ‘‘(A) is an eligible working individual with

15 a disability;

16 ‘‘(B) is a SSDI OPTIONS program partic17 ipant; or

18 ‘‘(C) engages in substantial gainful activity

19 in accordance with subsection (a) or (b) of sec20 tion 1619.

21 ‘‘(4) SSDI OPTIONS PROGRAM PARTICI22 PANT.—The term ‘SSDI OPTIONS program partic23 ipant’ has the meaning given that term in section

24 1181(3).
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1 ‘‘(5) WORK ELIGIBLE INDIVIDUAL.—The term

2 ‘work eligible individual’ means an individual who—

3 ‘‘(A) has attained age 16 but has not at4 tained age 65;

5 ‘‘(B) is entitled to cash benefits under sec6 tion 223 or eligible for supplemental security

7 income benefits under title XVI;

8 ‘‘(C) is not engaged in work, as determined

9 under the State plan; and

10 ‘‘(D) the State, in accordance with regula11 tions issued by the Secretary, determines is in

12 a transition to work readiness or is otherwise

13 work eligible.

14 ‘‘(6) WORK INCENTIVE SERVICES.—The term

15 ‘work incentive services’ means personal assistance

16 services and prescribed drugs.

17 ‘‘(b) STATE OPTION.—

18 ‘‘(1) IN GENERAL.—A State that elects through

19 a plan amendment to provide work incentive services

20 to qualified eligible working individuals with a dis21 ability and to work eligible individuals shall offer

22 such services in accordance with the provisions of

23 this section.

24 ‘‘(2) ELIGIBILITY.—Only a State that, as of the

25 date of enactment of this section, does not offer
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1 under the State plan or a waiver of such plan, serv2 ices that would otherwise be considered work incen3 tive services under this section to individuals who

4 would otherwise qualify for work incentive services

5 under this section, may elect to offer work incentive

6 services under this section.

7 ‘‘(3) MAINTENANCE OF EFFORT OF AMOUNTS

8 EXPENDED FOR SUPPORT OF INDIVIDUALS WITH

9 DISABILITIES.—A State that elects to offer work in10 centive services in accordance with this section may

11 not reduce the amount of State expenditures for in12 dividuals with disabilities below the level of such ex13 penditures in fiscal year 1997. For purposes of this

14 subparagraph, the term ‘State expenditures’ means

15 expenditures by the State from amounts other than

16 amounts made available by the Federal government

17 and for which no Federal match, reimbursement, or

18 payment is made.

19 ‘‘(4) WAIVER OF REQUIREMENTS.—The Sec20 retary may waive such provisions of this title as are

21 necessary to carry out the provisions of this section

22 other than—

23 ‘‘(A) section 1902(a)(1) (relating to

24 statewideness);
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1 ‘‘(B) subject to subsection (d), section

2 1902(a)(10)(B) (relating to comparability of

3 amount, duration, and scope of services); and

4 ‘‘(C) the requirements imposed under this

5 title for a State to provide services under the

6 State plan that are reasonable in amount, dura7 tion, and scope to achieve the purpose of such

8 services.

9 ‘‘(c) LIMITATIONS ON PREMIUMS AND COST-SHAR10 ING.—

11 ‘‘(1) INDIVIDUALS WITH INCOME BELOW 150

12 PERCENT OF POVERTY LINE.—In the case of a

13 qualified eligible working individual with a disability

14 or a work eligible individual whose income is at or

15 below 150 percent of the poverty line (as defined in

16 section 673(2) of the Community Services Block

17 Grant Act (42 U.S.C. 9902(2)), including any revi18 sion required by such section for a family of the size

19 involved), a State may not impose any enrollment

20 fee, premium, deductible, cost sharing, or similar

21 charge for receipt of work incentive services under

22 this section.

23 ‘‘(2) OTHER INDIVIDUALS.—In the case of a

24 qualified eligible working individual with a disability

25 or a work eligible individual who is not described in
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1 paragraph (1), a State may impose an enrollment

2 fee, premium, deductible, cost sharing, or similar

3 charge on a sliding scale basis related to income,

4 consistent with standards and regulations applicable

5 to such charges under section 1916.

6 ‘‘(d) PRIORITY FOR 16- THROUGH 25-YEAR-OLD

7 WORK ELIGIBLE INDIVIDUALS FOR PERSONAL ASSIST8 ANCE SERVICES.—A State shall give priority for receipt

9 of personal assistance services to work eligible individuals

10 who have attained age 16 but have not attained age 26.

11 ‘‘(e) ENHANCED FMAP.—Notwithstanding the first

12 sentence of section 1905(b), the Federal medical assist13 ance percentage for work incentive services provided under

14 this section is equal to the enhanced FMAP described in

15 section 2105(b).

16 ‘‘(f) OTHER REQUIREMENTS.—

17 ‘‘(1) CONSUMER CHOICE IN DELIVERY OF PER18 SONAL ASSISTANCE SERVICES.—A State shall pro19 vide qualified eligible working individuals with a dis20 ability and work eligible individuals with a choice of

21 provider models for receiving personal assistance

22 services in accordance with this section and may not

23 require that such services be ordered by a physician

24 in order to be available to such individuals.
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1 ‘‘(2) MEDICAID COVERAGE OF LAST RESORT.—

2 No payment may be made under this section for any

3 work incentive services provided under this section

4 to a qualified eligible working individual with a dis5 ability or a work eligible individual who is eligible for

6 coverage of such services under—

7 ‘‘(A) health benefits coverage offered by

8 the individual’s employer; or

9 ‘‘(B) any other coverage or payment avail10 able for such services, including a vocational re11 habilitation program.

12 ‘‘(3) APPEALS PROCESS.—Each State that

13 elects to provide work incentive services under this

14 section shall provide an appeals process for challeng15 ing the manner in which such services are provided

16 and the denial of such services, consistent with the

17 process for appealing other challenges to eligibility

18 for, or the extent of, coverage of items and services

19 under this title.

20 ‘‘(g) RULES OF CONSTRUCTION.—

21 ‘‘(1) LIMITATION ON ENTITLEMENT.—Except

22 as specifically provided under this section, nothing in

23 this title shall be construed as establishing any enti24 tlement of individuals described in subsection (a) to

25 any medical assistance provided under this title
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1 other than work incentive services provided in ac2 cordance with this section.

3 ‘‘(2) NO AFFECT ON OTHER BASIS FOR ELIGI4 BILITY.—Nothing in paragraph (1) shall be con5 strued as affecting the eligibility of an individual de6 scribed in subsection (a) for medical assistance

7 under this title on a basis that is unrelated to the

8 individual’s eligibility for work incentive services

9 under this section.

10 ‘‘(h) REGULATIONS.—Not later than 1 year after the

11 date of enactment of this section, the Secretary shall pub12 lish final regulations that set forth the requirements for

13 offering work incentive services in accordance with this

14 section.’’.

15 (b) CONFORMING AMENDMENTS.—

16 (1) Section 1902(a)(10) of the Social Security

17 Act (42 U.S.C. 1396a(a)(10)) is amended—

18 (A) in subparagraph (E), by striking

19 ‘‘and’’ at the end;

20 (B) in subparagraph (F), by adding ‘‘and’’

21 at the end; and

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

23 ‘‘(G) at the option of a State, for making

24 work incentive services available to qualified eli25 gible working individuals with a disability and
27

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1 work eligible individuals in accordance with sec2 tion 1929A;’’.

3 (2) Section 1902(a)(10)(C)(iv) of such Act (42

4 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting

5 ‘‘and (27)’’ after ‘‘(24)’’.

6 (3) Section 1903(f)(4) of the Social Security

7 Act (42 U.S.C. 1396b(f)(4)), as amended by section

8 162(4) of Public Law 105–100 (111 Stat. 2189), is

9 amended by striking ‘‘or 1905(u)’’ and inserting ‘‘,

10 1905(u), 1929A(a)’’.

11 (4) Section 1905(a) of the Social Security Act

12 (42 U.S.C. 1396d(a)), as amended by section 4802

13 of the Balanced Budget Act of 1997 (Public Law

14 105–33; 111 Stat. 538), is amended—

15 (A) by striking ‘‘and’’ at the end of para16 graph (26);

17 (B) by redesignating paragraph (27) as

18 paragraph (28); and

19 (C) by inserting after paragraph (26) the

20 following:

21 ‘‘(27) work incentive services (to the extent al22 lowed and as defined in section 1929A; and’’.

23 (5) Section 1905(b) is amended in the first sen24 tence by striking ‘‘section 1933(d)’’ and inserting

25 ‘‘sections 1929A(e) and 1933(d)’’.
28

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1 SEC. 202. EXTENSION OF MEDICARE BENEFITS FOR SSDI

2 OPTIONS PROGRAM PARTICIPANTS.

3 (a) IN GENERAL.—Title XVIII of the Social Security

4 Act (42 U.S.C. 1395 et seq.) is amended by inserting after

5 section 1818A the following:

6 ‘‘HOSPITAL INSURANCE AND MEDICAL SUPPLEMENTARY

7 INSURANCE BENEFITS FOR SSDI OPTIONS PROGRAM

8 PARTICIPANTS

9 ‘‘SEC. 1818B. (a) ELIGIBILITY.—Every individual

10 who—

11 ‘‘(1) is a SSDI OPTIONS program participant

12 (as defined in section 1181(3)); and

13 ‘‘(2) is not otherwise entitled to benefits under

14 this part;

15 shall be eligible to enroll in the insurance program estab16 lished by this part and part B.

17 ‘‘(b) ENROLLMENT.—The Secretary shall establish

18 procedures for enrollment under this section.

19 ‘‘(c) COVERAGE PERIOD.—

20 ‘‘(1) IN GENERAL.—The period during which

21 an individual described in subsection (a) is eligible

22 for benefits under the insurance program under this

23 part and part B (in this subsection referred to as a

24 ‘coverage period’) shall begin on the first day of the

25 month following the month in which the individual
29

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1 has begun participation in the OPTIONS program

2 established under part D of title XI.

3 ‘‘(2) TERMINATION.—An individual’s coverage

4 period under this section shall continue until the in5 dividual’s enrollment is terminated as follows:

6 ‘‘(A) As of the month following the month

7 in which the Secretary provides notice to the in8 dividual that the individual is no longer a SSDI

9 OPTIONS program participant.

10 ‘‘(B) As of the month following the month

11 in which the individual files notice that the indi12 vidual no longer wishes to participate in the in13 surance program established by this part and

14 part B.

15 ‘‘(C) Except as provided in subsection

16 (d)(4), as of the month following the month in

17 which the individual becomes eligible for health

18 benefits coverage offered by the individual’s em19 ployer.

20 ‘‘(D) As of the month before the first

21 month in which the individual becomes eligible

22 for hospital insurance benefits under section

23 226(a) or 226A.
30

•S 1858 IS

1 ‘‘(E) As of a date, determined under regu2 lations of the Secretary, for nonpayment of pre3 miums.

4 ‘‘(F) As of the month following the month

5 in which the date described in section 1187 oc6 curs.

7 The regulations under subparagraph (E) may pro8 vide a grace period of not longer than 90 days,

9 which may be extended for a period not to exceed

10 180 days in any case in which the Secretary deter11 mines that there was good cause for failure to pay

12 the overdue premiums within such 90-day period.

13 Termination of coverage under this section shall re14 sult in simultaneous termination of any other related

15 coverage provided to the individual under any other

16 part of this title.

17 ‘‘(d) PREMIUMS.—

18 ‘‘(1) IN GENERAL.—

19 ‘‘(A) PAYMENT TO SECRETARY.—Pre20 miums for enrollment under this section shall

21 be paid to the Secretary at such times, and in

22 such manner, as the Secretary shall by regula23 tions prescribe.

24 ‘‘(B) TRUST FUNDS.—
31

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1 ‘‘(i) PART A.—Premiums received by

2 the Secretary pursuant to subparagraph

3 (A) for coverage under this part shall be

4 deposited in the Treasury to the credit of

5 the Federal Hospital Insurance Trust

6 Fund.

7 ‘‘(ii) PART B.—Premiums received by

8 the Secretary pursuant to subparagraph

9 (A) for coverage under part B shall be de10 posited in the Treasury to the credit of the

11 Federal Supplementary Medical Insurance

12 Trust Fund.

13 ‘‘(C) COVERAGE PERIOD FOR PAYMENTS;

14 NO PAYMENTS WHEN OTHERWISE ELIGIBLE.—

15 ‘‘(i) COVERAGE PERIOD OF PAY16 MENTS.—Subject to clause (ii) and para17 graph (2)(A), such premiums shall be pay18 able for the period commencing with the

19 first month of an individual’s coverage pe20 riod and ending with the month in which

21 the individual dies or, if earlier, in which

22 the individual’s coverage period terminates.

23 ‘‘(ii) NO PAYMENTS WHEN OTHER24 WISE ELIGIBLE.—Such premiums shall not

25 be payable for any month in which the in-
32

•S 1858 IS

1 dividual is entitled to benefits under this

2 part pursuant to section 226(b).

3 ‘‘(2) AMOUNT.—

4 ‘‘(A) IN GENERAL.—Except as provided in

5 subparagraph (B), the amount of an individ6 ual’s premiums for any month in an individual’s

7 coverage period under this section shall be

8 equal to—

9 ‘‘(i) for coverage under this part, zero;

10 and

11 ‘‘(ii) for coverage under part B, the

12 amount of the premium determined under

13 section 1839(a)(3).

14 ‘‘(B) INDIVIDUALS WHOSE INCOME EX15 CEEDS 250 PERCENT OF POVERTY.—If an indi16 vidual’s earned income for any month in an in17 dividual’s coverage period during a calendar

18 year under this section (expressed as an annual

19 amount) exceeds the amount equal to 250 per20 cent of the poverty line (as defined in section

21 673(2) of the Community Services Block Grant

22 Act (42 U.S.C. 9902(2), including any revision

23 required by such section)) for a family of the

24 size involved for such calendar year, the amount
33

•S 1858 IS

1 of an individual’s premiums for such month

2 shall be equal to—

3 ‘‘(i) for coverage under this part, the

4 lesser of—

‘‘(I) 1 5 ⁄12 of 10 percent of the

6 amount of such excess income; or

7 ‘‘(II) the amount of the premium

8 determined under section 1818(d);

9 and

10 ‘‘(ii) for coverage under part B, the

11 amount of the premium determined under

12 section 1839(a)(3).

13 ‘‘(3) PAYMENT ON BEHALF OF INDIVIDUALS

14 ENROLLED UNDER THIS SECTION.—The provisions

15 of section 1818(e) (relating to payment of pre16 miums) shall apply to individuals enrolled under this

17 section in the same manner as such provisions apply

18 to individuals enrolled under that section.

19 ‘‘(4) ELECTION TO CONTINUE MEDICARE COV20 ERAGE FOR INDIVIDUALS PARTICIPATING IN AN EM21 PLOYER HEALTH PLAN.—

22 ‘‘(A) IN GENERAL.—Subsection (c)(2)(C)

23 shall not apply if an individual participates in

24 a health insurance plan offered by the individ-
34

•S 1858 IS

1 ual’s employer and the individual elects to con2 tinue to be enrolled under this section.

3 ‘‘(B) MEDICARE AS SECONDARY PAYER.—

4 ‘‘(i) IN GENERAL.—If an individual

5 enrolled under this section participates in

6 the health plan offered by the employer

7 and elects to continue to be enrolled under

8 this section pursuant to subparagraph

9 (A)—

10 ‘‘(I) the health insurance offered

11 by the employer shall be the primary

12 payer for any health care items and

13 services provided to such individual

14 and payment under this title for such

15 items and services shall be secondary

16 pursuant to section 1862(b)(2); and

17 ‘‘(II) the premium for enrollment

18 under this section shall be the pre19 mium determined under paragraph

20 (2).

21 ‘‘(ii) RULE OF CONSTRUCTION.—

22 Nothing in clause (i) shall be construed as

23 affecting the application of the payment

24 rules described in section 1862(b)(2).
35

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1 ‘‘(5) VERIFICATION AND ADJUSTMENTS OF

2 PREMIUMS.—

3 ‘‘(A) VERIFICATION.—Each individual to

4 whom this section applies shall, on the basis of

5 information shown on the return of tax imposed

6 by chapter 1 of the Internal Revenue Code of

7 1986 for any taxable year, determine the dif8 ference (if any) between—

9 ‘‘(i) the aggregate premiums imposed

10 by this section for months during the cal11 endar year in which the taxable year be12 gins; and

13 ‘‘(ii) the aggregate amount of pre14 miums paid under this section for such

15 months with respect to the individual.

16 Such determination shall be included on a form

17 prescribed by the Secretary and the form shall

18 be submitted to the Secretary at such time and

19 in such manner as the Secretary shall prescribe.

20 ‘‘(B) DEFICIENCY ADJUSTMENTS.—

21 ‘‘(i) IN GENERAL.—If the amount

22 under subparagraph (A)(i) exceeds the

23 amount under subparagraph (A)(ii), the

24 individual shall include with the form re25 quired to be filed under subparagraph (A)
36

•S 1858 IS

1 a separate check made payable to the Sec2 retary in an amount equal to such excess

3 plus interest determined under clause (ii).

4 ‘‘(ii) INTEREST ON UNDERPAY5 MENTS.—For purposes of clause (i)—

6 ‘‘(I) IN GENERAL.—The amount

7 of interest taken into account shall be

8 the sum of the amounts determined

9 under subclause (II) for each of the

10 months in the taxable year.

11 ‘‘(II) MONTHLY INTEREST.—In12 terest shall be computed for any

13 month in an amount determined by

14 applying the underpayment rate es15 tablished under section 6621 of the

16 Internal Revenue Code of 1986 to any

17 portion of the underpayment for the

18 period beginning on the first day of

19 the following month and ending on

20 the date the portion is paid. For pur21 poses of this subclause, payments

22 shall be applied to months in order,

23 beginning with the earliest.

24 ‘‘(III) SAFE-HARBOR EXCEP25 TION.—No interest shall be imposed
37

•S 1858 IS

1 for any month if the individual’s esti2 mate of earned income under para3 graph (2) on which the premium for

4 the month was based was not less

5 than the individual’s earned income

6 determined on the basis of informa7 tion shown on the return of tax im8 posed by chapter 1 of such Code for

9 the taxable year ending with or within

10 the calendar year preceding the cal11 endar year in which the estimate was

12 made.

13 ‘‘(C) OVERPAYMENT ADJUSTMENTS.—If

14 the amount under subparagraph (A)(ii) exceeds

15 the amount under subparagraph (A)(i), the Sec16 retary shall, at the Secretary’s discretion—

17 ‘‘(i) credit such excess against any

18 premium required under this section; or

19 ‘‘(ii) make a payment to the individual

20 in the amount of such excess.

21 ‘‘(D) ADJUSTMENTS BY SECRETARY.—If

22 the Secretary determines, on the basis of infor23 mation received from the Secretary of the

24 Treasury under section 6103(l)(17) of the In25 ternal Revenue Code of 1986, that there was an
38

•S 1858 IS

1 underpayment or overpayment of the aggregate

2 premiums for months during any taxable year

3 (after any other adjustment under this para4 graph), the Secretary shall—

5 ‘‘(i) notify the individual of such un6 derpayment or overpayment,

7 ‘‘(ii) in the case of an under8 payment—

9 ‘‘(I) give such individual an op10 portunity for a hearing with respect to

11 such underpayment and a reasonable

12 time for payment of such under13 payment and interest determined

14 under subparagraph (B)(i), and

15 ‘‘(II) collect the amount of any

16 underpayment and interest not paid

17 under subclause (I) in such manner as

18 the Secretary may prescribe, and

19 ‘‘(iii) in the case of an overpayment,

20 take the actions described in subparagraph

21 (C).

22 ‘‘(6) EARNED INCOME.—For purposes of this

23 subsection, the term ‘earned income’ has the mean24 ing given such term by section 32(c)(2) of the Inter25 nal Revenue Code of 1986.
39

•S 1858 IS

1 ‘‘(7) AGREEMENT WITH COMMISSIONER.—In

2 order to promote the efficient administration of this

3 subsection, the Secretary may enter into an agree4 ment with the Commissioner of Social Security

5 under which the Commissioner performs administra6 tive responsibilities under this subsection.’’.

7 (b) DISCLOSURE OF INFORMATION.—Section 6103(l)

8 of the Internal Revenue Code of 1986 (relating to disclo9 sure of returns and return information for purposes other

10 than tax administration) is amended by adding at the end

11 the following:

12 ‘‘(17) DISCLOSURE OF TAXPAYER RETURN IN13 FORMATION TO SOCIAL SECURITY ADMINISTRATION

14 FOR PURPOSES OF COLLECTING PREMIUMS FOR A

15 SSDI OPTIONS PROGRAM PARTICIPANT.—

16 ‘‘(A) IN GENERAL.—The Secretary shall,

17 upon written request from the Secretary of

18 Health and Human Services, disclose to the

19 Secretary with respect to a SSDI OPTIONS

20 program participant identified in the request

21 whether or not (and the amount by which) the

22 participant’s earned income for any taxable

23 year specified in the request exceeded the

24 amount specified in section 1818B(d)(2)(B).
40

•S 1858 IS

1 ‘‘(B) RESTRICTION ON USE.—Return in2 formation disclosed under subparagraph (A)

3 may be used by officers and employees of the

4 Department of Health and Human Services (or

5 of the Social Security Administration if section

6 1818B(d)(7) of the Social Security Act applies)

7 only for the purposes of, and to the extent nec8 essary in, establishing a participant’s correct

9 premium under section 1818B of the such Act.

10 ‘‘(C) DEFINITIONS.—For purposes of this

11 paragraph, any term used that is also used in

12 section 1818B of the Social Security Act shall

13 have the meaning given such term by such sec14 tion.’’.

15 TITLE III—DEMONSTRATION

16 PROJECTS AND OUTREACH

17 SEC. 301. DEMONSTRATION PROJECTS.

18 (a) EXTENSION OF DISABILITY INSURANCE PRO19 GRAM DEMONSTRATION PROJECT AUTHORITY.—Section

20 505 of the Social Security Disability Amendments of 1980

21 (42 U.S.C. 1310 note) is amended—

22 (1) in subsection (a)—

23 (A) in paragraph (1)—

24 (i) by inserting ‘‘(A)’’ after ‘‘(1)’’;
41

•S 1858 IS

1 (ii) by striking ‘‘(A) various’’ and in2 serting ‘‘(i) various’’;

3 (iii) by striking ‘‘and (B)’’ and insert4 ing ‘‘, (ii)’’;

5 (iv) by striking the period and insert6 ing ‘‘, and (iii) implementing sliding scale

7 benefit offsets using variations in the

8 amount of the offset as a proportion of

9 earned income, the duration of the offset

10 period, and the method of determining the

11 amount of income earned by the bene12 ficiaries, and using state-of-the-art infor13 mation technology and electronic funds

14 transfer technology to streamline the re15 porting of data and the implementation of

16 the offsets, and developing and making

17 available to beneficiaries, their families,

18 guardians, and advocates, through the

19 Internet information regarding work incen20 tives and assistance for beneficiaries to

21 make informed decisions regarding work.’’;

22 and

23 (v) by adding at the end the following:

24 ‘‘(B) The Commissioner may expand the scope of any

25 experiment or demonstration project described in subpara-
42

•S 1858 IS

1 graph (A) to include any group of participants with im2 pairments that reasonably may be presumed to be dis3 abled, and may limit any such experiment or demonstra4 tion project to any such group of individuals, subject to

5 the terms of such experiment or demonstration project.

6 The Commissioner shall define the extent of any presump7 tion that is the basis for an expansion described in the

8 preceding sentence.’’;

9 (B) in paragraph (3), by striking ‘‘1996’’

10 and inserting ‘‘1999’’; and

11 (C) in paragraph (4), by striking ‘‘of the

12 succeeding years through 1995’’ and inserting

13 ‘‘year thereafter’’; and

14 (2) in subsection (c), by striking ‘‘October 1,

15 1996’’ and inserting ‘‘1 year after the conclusion of

16 each such experiment and demonstration project’’.

17 (b) REQUIREMENTS FOR CONSIDERATION OF WAIV18 ERS TO REDUCE WORK DISINCENTIVES.—Section 1115

19 of the Social Security Act (42 U.S.C. 1315) is amended

20 by inserting after subsection (c) the following:

21 ‘‘(d)(1) In the case of any request for a waiver under

22 this section that is for the purpose of conducting an exper23 imental, pilot, or demonstration project that is designed

24 to reduce work disincentives for individuals with disabil25 ities, the Secretary shall take into account reductions in
43

•S 1858 IS

1 payments made to such individuals under titles II and

2 XVI, and other reductions in Federal expenditures that

3 are related to Federally-subsidized assistance for, or sup4 port of, such individuals, when the reduced expenditures

5 are related to the fact that the individuals have earned

6 income.

7 ‘‘(2)(A) Not later than 90 days after the date the

8 Secretary receives a request to conduct an experimental,

9 pilot, or demonstration project that is designed to reduce

10 work disincentives for individuals with disabilities and that

11 is limited to not more than 5000 such individuals, the Sec12 retary shall approve or disapprove the request, or inform

13 the State that specified additional information is needed

14 to review the request.

15 ‘‘(B) In the case of a request described in subpara16 graph (A) in which the Secretary has specified that addi17 tional information is needed, the Secretary shall approve

18 or disapprove the request not later than 90 days after the

19 date the additional information is submitted.’’.

20 (c) SENSE OF CONGRESS REGARDING ADDITIONAL

21 DEMONSTRATION PROJECTS.—It is the sense of Congress

22 that the Commissioner of Social Security and the Sec23 retary of Health and Human Services should establish ad24 ditional demonstration projects to assist individuals with

25 disabilities engage in work.
44

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1 SEC. 302. INFORMATION AND OUTREACH REGARDING

2 WORK OPPORTUNITIES FOR INDIVIDUALS

3 WITH A DISABILITY.

4 (a) ESTABLISHMENT.—The Commissioner of Social

5 Security shall establish and conduct directly, or through

6 grants, contracts, or interagency agreements, an ongoing

7 program of outreach to individuals with disabilities who

8 are potentially eligible to participate in the OPTIONS pro9 gram established under part D of title XI of the Social

10 Security Act or to engage in substantial gainful activity

11 in accordance with subsections (a) and (b) of section 1619

12 of such Act (42 U.S.C. 1382h) and to the families of such

13 individuals.

14 (b) REQUIREMENTS.—Under the program estab15 lished in accordance with this section, the Commissioner

16 of Social Security shall—

17 (1) prepare and disseminate information ex18 plaining the OPTIONS program established under

19 part D of title XI of the Social Security Act and the

20 opportunity to engage in substantial gainful activity

21 in accordance with subsections (a) and (b) of section

22 1619 of such Act (42 U.S.C. 1382h); and

23 (2) work in cooperation with other Federal,

24 State, and private agencies and nonprofit organiza25 tions that serve disabled individuals, and with agen-
45

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1 cies and organizations that focus on vocational reha2 bilitation and work-related training and counseling.

3 TITLE IV—MISCELLANEOUS

4 SEC. 401. REPORT AND RECOMMENDATIONS TO CONGRESS.

5 Not later than 12 months after the date of enactment

6 of this Act, the Commissioner of Social Security and the

7 Secretary of Health and Human Services shall jointly sub8 mit to Congress a report containing recommendations for

9 any administrative or legislative changes, including to the

10 OPTIONS program for working individuals with disabil11 ities established under part D of title XI of the Social Se12 curity Act (and the health care benefits provided under

13 sections 1818B and 1929A of such Act), that the Commis14 sioner and the Secretary determine would be appropriate

15 to reduce work disincentives for individuals with disabil16 ities.

17 SEC. 402. EFFECTIVE DATES.

18 (a) IN GENERAL.—Except as provided in subsections

19 (b) and (c), this Act takes effect on the date of enactment

20 of this Act.

21 (b) EXCEPTIONS.—The amendments made by titles

22 I and II shall take effect on the date that is 1 year after

23 the date of enactment of this Act.

24 (c) EXTENSION OF EFFECTIVE DATE FOR STATE

25 LAW AMENDMENT.—In the case of a State plan under
46

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1 title XIX of the Social Security Act that the Secretary

2 of Health and Human Services determines requires State

3 legislation in order for the plan to meet the additional re4 quirements imposed by the amendments made in section

5 201 of this Act, the State plan shall not be regarded as

6 failing to comply with the requirements of such title solely

7 on the basis of its failure to meet these additional require8 ments before the first day of the first calendar quarter

9 beginning after the close of the first regular session of the

10 State legislature that begins after the date of enactment

11 of this Act. For purposes of the previous sentence, in the

12 case of a State that has a 2-year legislative session, each

13 year of the session is considered to be a separate regular

14 session of the State legislature.

Æ