II 

110TH CONGRESS 

1ST SESSION S. 794 

To amend titles XIX and XXI of the Social Security Act to provide States 

with the option to expand or add coverage of pregnant women under 

the Medicaid and State children’s health insurance programs, and for 

other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 7, 2007 

Mrs. LINCOLN (for herself, Mr. LUGAR, Mr. BINGAMAN, and Ms. SNOWE) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to provide States with the option to expand or add coverage of pregnant women under the Medicaid and State 

children’s health insurance programs, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Prevent Prematurity 

5 and Improve Child Health Act of 2007’’. 


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1 SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF 

2 CERTAIN PREGNANT WOMEN UNDER MED3 ICAID AND SCHIP. 

4 (a) MEDICAID.— 

5 (1) AUTHORITY TO EXPAND COVERAGE.—Sec6 tion 1902(l)(2)(A)(i) of the Social Security Act (42 

7 U.S.C. 1396a(l)(2)(A)(i)) is amended by inserting 

8 ‘‘(or such higher percentage as the State may elect 

9 for purposes of expenditures for medical assistance 

10 for pregnant women described in section 

11 1905(u)(4)(A))’’ after ‘‘185 percent’’. 

12 (2) ENHANCED MATCHING FUNDS AVAILABLE

13 IF CERTAIN CONDITIONS MET.—Section 1905 of the 

14 Social Security Act (42 U.S.C. 1396d) is amended— 

15 (A) in the fourth sentence of subsection 

16 (b), by striking ‘‘or subsection (u)(3)’’ and in17 serting ‘‘, (u)(3), or (u)(4)’’; and 

18 (B) in subsection (u)— 

19 (i) by redesignating paragraph (4) as 

20 paragraph (5); and 

21 (ii) by inserting after paragraph (3) 

22 the following new paragraph: 

23 ‘‘(4) For purposes of the fourth sentence of sub24 section (b) and section 2105(a), the expenditures de25 scribed in this paragraph are the following: 


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1 ‘‘(A) CERTAIN PREGNANT WOMEN.—If the con2 ditions described in subparagraph (B) are met, ex3 penditures for medical assistance for pregnant 

4 women described in subsection (n) or in section 

5 1902(l)(1)(A) in a family the income of which ex6 ceeds 185 percent of the poverty line, but does not 

7 exceed the income eligibility level established under 

8 title XXI for a targeted low-income child. 

9 ‘‘(B) CONDITIONS.—The conditions described 

10 in this subparagraph are the following: 

11 ‘‘(i) The State plans under this title and 

12 title XXI do not provide coverage for pregnant 

13 women described in subparagraph (A) with 

14 higher family income without covering such 

15 pregnant women with a lower family income. 

16 ‘‘(ii) The State does not apply an effective 

17 income level for pregnant women that is lower 

18 than the effective income level (expressed as a 

19 percent of the poverty line and considering ap20 plicable income disregards) specified under the 

21 State plan under subsection (a)(10)(A)(i)(III) 

22 or (l)(2)(A) of section 1902, on January 1, 

23 2008, to be eligible for medical assistance as a 

24 pregnant woman. 


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1 ‘‘(C) DEFINITION OF POVERTY LINE.—In this 

2 subsection, the term ‘poverty line’ has the meaning 

3 given such term in section 2110(c)(5).’’. 

4 (3) PAYMENT FROM TITLE XXI ALLOTMENT

5 FOR MEDICAID EXPANSION COSTS; ELIMINATION OF

6 COUNTING MEDICAID CHILD PRESUMPTIVE ELIGI7 BILITY COSTS AGAINST TITLE XXI ALLOTMENT.— 

8 Section 2105(a)(1) of the Social Security Act (42 

9 U.S.C. 1397ee(a)(1)) is amended— 

10 (A) in the matter preceding subparagraph 

11 (A), by striking ‘‘(or, in the case of expendi12 tures described in subparagraph (B), the Fed13 eral medical assistance percentage (as defined 

14 in the first sentence of section 1905(b)))’’; and 

15 (B) by striking subparagraph (B) and in16 serting the following new subparagraph: 

17 ‘‘(B) for the provision of medical assist18 ance that is attributable to expenditures de19 scribed in section 1905(u)(4)(A);’’. 

20 (b) SCHIP.— 

21 (1) COVERAGE.—Title XXI of the Social Secu22 rity Act (42 U.S.C. 1397aa et seq.) is amended by 

23 adding at the end the following new section: 


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1 ‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN2 COME PREGNANT WOMEN. 

3 ‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 

4 other provision of this title, a State may provide for cov5 erage, through an amendment to its State child health 

6 plan under section 2102, of pregnancy-related assistance 

7 for targeted low-income pregnant women in accordance 

8 with this section, but only if— 

9 ‘‘(1) the State has established an income eligi10 bility level for pregnant women under subsection 

11 (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 that is 

12 at least 185 percent of the income official poverty 

13 line; and 

14 ‘‘(2) the State meets the conditions described in 

15 section 1905(u)(4)(B). 

16 ‘‘(b) DEFINITIONS.—For purposes of this title: 

17 ‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 

18 term ‘pregnancy-related assistance’ has the meaning 

19 given the term ‘child health assistance’ in section 

20 2110(a) as if any reference to targeted low-income 

21 children were a reference to targeted low-income 

22 pregnant women. 

23 ‘‘(2) TARGETED LOW-INCOME PREGNANT

24 WOMAN.—The term ‘targeted low-income pregnant 

25 woman’ means a woman— 


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1 ‘‘(A) during pregnancy and through the 

2 end of the month in which the 60-day period 

3 (beginning on the last day of her pregnancy) 

4 ends; 

5 ‘‘(B) whose family income exceeds the ef6 fective income level (expressed as a percent of 

7 the poverty line and considering applicable in8 come disregards) specified under subsection 

9 (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902, 

10 on January 1, 2008, to be eligible for medical 

11 assistance as a pregnant woman under title 

12 XIX but does not exceed the income eligibility 

13 level established under the State child health 

14 plan under this title for a targeted low-income 

15 child; and 

16 ‘‘(C) who satisfies the requirements of 

17 paragraphs (1)(A), (1)(C), (2), and (3) of sec18 tion 2110(b) in the same manner as a child ap19 plying for child health assistance would have to 

20 satisfy such requirements. 

21 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

22 RULES.—In the case of, and with respect to, a State pro23 viding for coverage of pregnancy-related assistance to tar24 geted low-income pregnant women under subsection (a), 

25 the following special rules apply: 


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1 ‘‘(1) Any reference in this title (other than in 

2 subsection (b)) to a targeted low-income child is 

3 deemed to include a reference to a targeted low-in4 come pregnant woman. 

5 ‘‘(2) Any such reference to child health assist6 ance with respect to such women is deemed a ref7 erence to pregnancy-related assistance. 

8 ‘‘(3) Any such reference to a child is deemed a 

9 reference to a woman during pregnancy and the pe10 riod described in subsection (b)(2)(A). 

11 ‘‘(4) In applying section 2102(b)(3)(B), any 

12 reference to children found through screening to be 

13 eligible for medical assistance under the State Med14 icaid plan under title XIX is deemed a reference to 

15 pregnant women. 

16 ‘‘(5) There shall be no exclusion of benefits for 

17 services described in subsection (b)(1) based on any 

18 preexisting condition and no waiting period (includ19 ing any waiting period imposed to carry out section 

20 2102(b)(3)(C)) shall apply. 

21 ‘‘(6) In applying section 2103(e)(3)(B) in the 

22 case of a pregnant woman provided coverage under 

23 this section, the limitation on total annual aggregate 

24 cost sharing shall be applied to such pregnant 

25 woman. 


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1 ‘‘(7) The reference in section 2107(e)(1)(D) to 

2 section 1920A (relating to presumptive eligibility for 

3 children) is deemed a reference to section 1920 (re4 lating to presumptive eligibility for pregnant 

5 women). 

6 ‘‘(d) AUTOMATIC ENROLLMENT FOR CHILDREN

7 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS8 SISTANCE.—If a child is born to a targeted low-income 

9 pregnant woman who was receiving pregnancy-related as10 sistance under this section on the date of the child’s birth, 

11 the child shall be deemed to have applied for child health 

12 assistance under the State child health plan and to have 

13 been found eligible for such assistance under such plan 

14 or to have applied for medical assistance under title XIX 

15 and to have been found eligible for such assistance under 

16 such title, as appropriate, on the date of such birth and 

17 to remain eligible for such assistance until the child at18 tains 1 year of age. During the period in which a child 

19 is deemed under the preceding sentence to be eligible for 

20 child health or medical assistance, the child health or med21 ical assistance eligibility identification number of the 

22 mother shall also serve as the identification number of the 

23 child, and all claims shall be submitted and paid under 

24 such number (unless the State issues a separate identifica25 tion number for the child before such period expires).’’. 


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1 (2) ADDITIONAL ALLOTMENTS FOR PROVIDING

2 COVERAGE OF PREGNANT WOMEN.— 

3 (A) IN GENERAL.—Section 2104 of the So4 cial Security Act (42 U.S.C. 1397dd) is amend5 ed by adding at the end the following new sub6 section: 

7 ‘‘(h) ADDITIONAL ALLOTMENTS FOR PROVIDING

8 COVERAGE OF PREGNANT WOMEN.— 

9 ‘‘(1) APPROPRIATION; TOTAL ALLOTMENT.— 

10 For the purpose of providing additional allotments 

11 to States under this title, there is appropriated, out 

12 of any money in the Treasury not otherwise appro13 priated, for each of fiscal years 2008 through 2012, 

14 $200,000,000. 

15 ‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.— 

16 In addition to the allotments provided under sub17 sections (b) and (c), subject to paragraphs (3) and 

18 (4), of the amount available for the additional allot19 ments under paragraph (1) for a fiscal year, the 

20 Secretary shall allot to each State with a State child 

21 health plan approved under this title— 

22 ‘‘(A) in the case of such a State other than 

23 a commonwealth or territory described in sub24 paragraph (B), the same proportion as the pro25 portion of the State’s allotment under subVerDate Aug 31 2005 04:15 Mar 08, 2007 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S794.IS S794

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1 section (b) (determined without regard to sub2 section (f)) to the total amount of the allot3 ments under subsection (b) for such States eli4 gible for an allotment under this paragraph for 

5 such fiscal year; and 

6 ‘‘(B) in the case of a commonwealth or ter7 ritory described in subsection (c)(3), the same 

8 proportion as the proportion of the common9 wealth’s or territory’s allotment under sub10 section (c) (determined without regard to sub11 section (f)) to the total amount of the allot12 ments under subsection (c) for commonwealths 

13 and territories eligible for an allotment under 

14 this paragraph for such fiscal year. 

15 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi16 tional allotments provided under this subsection are 

17 not available for amounts expended before October 

18 1, 2007. Such amounts are available for amounts ex19 pended on or after such date for child health assist20 ance for targeted low-income children, as well as for 

21 pregnancy-related assistance for targeted low-income 

22 pregnant women. 

23 ‘‘(4) NO PAYMENTS UNLESS ELECTION TO EX24 PAND COVERAGE OF PREGNANT WOMEN.—No pay25 ments may be made to a State under this title from 


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1 an allotment provided under this subsection unless 

2 the State provides pregnancy-related assistance for 

3 targeted low-income pregnant women under this 

4 title, or provides medical assistance for pregnant 

5 women under title XIX, whose family income ex6 ceeds the effective income level applicable under sub7 section (a)(10)(A)(i)(III) or (l)(2)(A) of section 

8 1902 to a family of the size involved on January 1, 

9 2008.’’. 

10 (B) CONFORMING AMENDMENTS.—Section 

11 2104 of the Social Security Act (42 U.S.C. 

12 1397dd) is amended— 

13 (i) in subsection (a), in the matter 

14 preceding paragraph (1), by striking ‘‘sub15 section (d)’’ and inserting ‘‘subsections (d) 

16 and (h)’’; 

17 (ii) in subsection (b)(1), by striking 

18 ‘‘subsection (d)’’ and inserting ‘‘sub19 sections (d) and (h)’’; and 

20 (iii) in subsection (c)(1), by striking 

21 ‘‘subsection (d),’’ and inserting ‘‘sub22 sections (d) and (h)’’. 

23 (3) ADDITIONAL CONFORMING AMENDMENTS.— 

24 (A) NO COST SHARING FOR PREGNANCY25 RELATED BENEFITS.—Section 2103(e)(2) of 


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

2 1397cc(e)(2)) is amended— 

3 (i) in the heading, by inserting ‘‘OR

4 PREGNANCY-RELATED SERVICES’’ after 

5 ‘‘PREVENTIVE SERVICES’’; and 

6 (ii) by inserting before the period at 

7 the end the following: ‘‘or for pregnancy8 related services’’. 

9 (B) NO WAITING PERIOD.—Section 

10 2102(b)(1)(B) of the Social Security Act (42 

11 U.S.C. 1397bb(b)(1)(B)) is amended— 

12 (i) in clause (i), by striking ‘‘, and’’ at 

13 the end and inserting a semicolon; 

14 (ii) in clause (ii), by striking the pe15 riod at the end and inserting ‘‘; and’’; and 

16 (iii) by adding at the end the fol17 lowing new clause: 

18 ‘‘(iii) may not apply a waiting period 

19 (including a waiting period to carry out 

20 paragraph (3)(C)) in the case of a targeted 

21 low-income pregnant woman.’’. 

22 (c) AUTHORITY FOR STATES THAT PROVIDE MED23 ICAID OR SCHIP COVERAGE FOR PREGNANT WOMEN

24 WITH INCOME ABOVE 185 PERCENT OF THE POVERTY

25 LINE TO USE PORTION OF SCHIP FUNDS FOR MEDICAID


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1 EXPENDITURES.—Section 2105(g) of the Social Security 

2 Act (42 U.S.C. 1397ee(g)) is amended— 

3 (1) in the subsection heading, by inserting 

4 ‘‘AND CERTAIN PREGNANCY COVERAGE EXPANSION

5 STATES’’ after ‘‘QUALIFYING STATES’’; 

6 (2) by adding at the end the following: 

7 ‘‘(4) SPECIAL AUTHORITY FOR CERTAIN PREG8 NANCY COVERAGE EXPANSION STATES.— 

9 ‘‘(A) IN GENERAL.—In the case of a State 

10 that, as of the date of enactment of the Prevent 

11 Prematurity and Improve Child Health Act of 

12 2007, has an income eligibility standard under 

13 title XIX or this title (under section 

14 1902(a)(10)(A) or under a statewide waiver in 

15 effect under section 1115 with respect to title 

16 XIX or this title) that is at least 185 percent 

17 of the poverty line with respect to pregnant 

18 women, the State may elect to use not more 

19 than 20 percent of any allotment under section 

20 2104 for any fiscal year (insofar as it is avail21 able under any subsection of such section) for 

22 payments under title XIX in accordance with 

23 subparagraph (B), instead of for expenditures 

24 under this title. 

25 ‘‘(B) PAYMENTS TO STATES.— 


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1 ‘‘(i) IN GENERAL.—In the case of a 

2 State described in subparagraph (A) that 

3 has elected the option described in that 

4 subparagraph, subject to the availability of 

5 funds under such subparagraph and, if ap6 plicable, paragraph (1)(A), with respect to 

7 the State, the Secretary shall pay the State 

8 an amount each quarter equal to the addi9 tional amount that would have been paid 

10 to the State under title XIX with respect 

11 to expenditures described in clause (ii) if 

12 the enhanced FMAP (as determined under 

13 subsection (b)) had been substituted for 

14 the Federal medical assistance percentage 

15 (as defined in section 1905(b)). 

16 ‘‘(ii) EXPENDITURES DESCRIBED.— 

17 For purposes of this subparagraph, the ex18 penditures described in this clause are ex19 penditures, made after the date of the en20 actment of this paragraph and during the 

21 period in which funds are available to the 

22 State for use under subparagraph (A), for 

23 medical assistance under title XIX for 

24 pregnant women whose family income is at 

25 least 185 percent of the poverty line. 


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1 ‘‘(iii) NO IMPACT ON DETERMINATION

2 OF BUDGET NEUTRALITY FOR WAIVERS.— 

3 In the case of a State described in sub4 paragraph (A) that uses amounts paid 

5 under this paragraph for expenditures de6 scribed in clause (ii) that are incurred 

7 under a waiver approved for the State, any 

8 budget neutrality determinations with re9 spect to such waiver shall be determined 

10 without regard to such amounts paid.’’; 

11 and 

12 (3) in paragraph (3), by striking ‘‘and (2)’’ and 

13 inserting ‘‘(2), and (4)’’. 

14 (d) OTHER AMENDMENTS TO MEDICAID.— 

15 (1) ELIGIBILITY OF ANEWBORN.—Section 

16 1902(e)(4) of the Social Security Act (42 U.S.C. 

17 1396a(e)(4)) is amended in the first sentence by 

18 striking ‘‘so long as the child is a member of the 

19 woman’s household and the woman remains (or 

20 would remain if pregnant) eligible for such assist21 ance’’. 

22 (2) APPLICATION OF QUALIFIED ENTITIES TO

23 PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN

24 UNDER MEDICAID.—Section 1920(b) of the Social 

25 Security Act (42 U.S.C. 1396r–1(b)) is amended by 


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1 adding after paragraph (2) the following flush sen2 tence: 

3 ‘‘The term ‘qualified provider’ includes a qualified entity 

4 as defined in section 1920A(b)(3).’’. 

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

6 this section apply to items and services furnished on or 

7 after October 1, 2007, without regard to whether regula8 tions implementing such amendments have been promul9 gated. 

10 SEC. 3. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 

11 UNDER THE MEDICAID PROGRAM AND SCHIP. 

12 (a) MEDICAID PROGRAM.—Section 1903(v) of the 

13 Social Security Act (42 U.S.C. 1396b(v)) is amended— 

14 (1) in paragraph (1), by striking ‘‘paragraph 

15 (2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 

16 (2) by adding at the end the following new 

17 paragraph: 

18 ‘‘(4)(A) A State may elect (in a plan amendment 

19 under this title) to provide medical assistance under this 

20 title for aliens who are lawfully residing in the United 

21 States (including battered aliens described in section 

22 431(c) of the Personal Responsibility and Work Oppor23 tunity Reconciliation Act of 1996) and who are otherwise 

24 eligible for such assistance, within any of the following eli25 gibility categories: 


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1 ‘‘(i) PREGNANT WOMEN.—Women during preg2 nancy (and during the 60-day period beginning on 

3 the last day of the pregnancy). 

4 ‘‘(ii) CHILDREN.—Children (as defined under 

5 such plan), including optional targeted low-income 

6 children described in section 1905(u)(2)(B). 

7 ‘‘(B)(i) In the case of a State that has elected to pro8 vide medical assistance to a category of aliens under sub9 paragraph (A), no debt shall accrue under an affidavit of 

10 support against any sponsor of such an alien on the basis 

11 of provision of assistance to such category and the cost 

12 of such assistance shall not be considered as an unreim13 bursed cost. 

14 ‘‘(ii) The provisions of sections 401(a), 402(b), 403, 

15 and 421 of the Personal Responsibility and Work Oppor16 tunity Reconciliation Act of 1996 shall not apply to a 

17 State that makes an election under subparagraph (A).’’. 

18 (b) TITLE XXI.—Section 2107(e)(1) of the Social 

19 Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add20 ing at the end the following new subparagraph: 

21 ‘‘(E) Section 1903(v)(4) (relating to op22 tional coverage of permanent resident alien 

23 pregnant women and children), but only with 

24 respect to an eligibility category under this title, 


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1 if the same eligibility category has been elected 

2 under such section for purposes of title XIX.’’. 

3 (c) EFFECTIVE DATE.—The amendments made by 

4 this section take effect on October 1, 2007, and apply to 

5 medical assistance and child health assistance furnished 

6 on or after such date. 

7 SEC. 4. PROMOTING CESSATION OF TOBACCO USE UNDER 

8 THE MEDICAID PROGRAM. 

9 (a) DROPPING EXCEPTION FROM MEDICAID PRE10 SCRIPTION DRUG COVERAGE FOR TOBACCO CESSATION

11 MEDICATIONS.—Section 1927(d)(2) of the Social Security 

12 Act (42 U.S.C. 1396r–8(d)(2)) is amended— 

13 (1) by striking subparagraph (E); 

14 (2) by redesignating subparagraphs (F) 

15 through (J) as subparagraphs (E) through (I), re16 spectively; and 

17 (3) in subparagraph (F) (as redesignated by 

18 paragraph (2)), by inserting before the period at the 

19 end the following: ‘‘, except agents approved by the 

20 Food and Drug Administration for purposes of pro21 moting, and when used to promote, tobacco ces22 sation’’. 

23 (b) REQUIRING COVERAGE OF TOBACCO CESSATION

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1 tion 1905 of the Social Security Act (42 U.S.C. 

2 1396d(a)(4)) is amended— 

3 (1) in subsection (a)(4)— 

4 (A) by striking ‘‘and’’ before ‘‘(C)’’; and 

5 (B) by inserting before the semicolon at 

6 the end the following new subparagraph: ‘‘; and 

7 (D) counseling for cessation of tobacco use (as 

8 defined in subsection (y)) for pregnant women’’; 

9 and 

10 (2) by adding at the end the following: 

11 ‘‘(y)(1) For purposes of this title, the term ‘coun12 seling for cessation of tobacco use’ means therapy and 

13 counseling for cessation of tobacco use for pregnant 

14 women who use tobacco products or who are being treated 

15 for tobacco use that is furnished— 

16 ‘‘(A) by or under the supervision of a physician; 

17 or 

18 ‘‘(B) by any other health care professional 

19 who— 

20 ‘‘(i) is legally authorized to furnish such 

21 services under State law (or the State regu22 latory mechanism provided by State law) of the 

23 State in which the services are furnished; and 


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1 ‘‘(ii) is authorized to receive payment for 

2 other services under this title or is designated 

3 by the Secretary for this purpose. 

4 ‘‘(2) Subject to paragraph (3), such term is limited 

5 to— 

6 ‘‘(A) therapy and counseling services rec7 ommended in ‘Treating Tobacco Use and Depend8 ence: A Clinical Practice Guideline’, published by the 

9 Public Health Service in June 2000, or any subse10 quent modification of such Guideline; and 

11 ‘‘(B) such other therapy and counseling services 

12 that the Secretary recognizes to be effective. 

13 ‘‘(3) Such term shall not include coverage for drugs 

14 or biologicals that are not otherwise covered under this 

15 title.’’. 

16 (c) REMOVAL OF COST SHARING FOR TOBACCO CES17 SATION COUNSELING SERVICES FOR PREGNANT

18 WOMEN.— 

19 (1) GENERAL COST SHARING LIMITATIONS.— 

20 Section 1916 of the Social Security Act (42 U.S.C. 

21 1396o) is amended in each of subsections (a)(2)(B) 

22 and (b)(2)(B) by inserting ‘‘, and counseling for ces23 sation of tobacco use (as defined in section 

24 1905(y))’’ after ‘‘complicate the pregnancy’’. 


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1 (2) APPLICATION TO ALTERNATIVE COST SHAR2 ING.—Section 1916A(b)(3)(B)(iii) of such Act (42 

3 U.S.C. 1396o–1(b)(3)(B)(iii)) is amended by insert4 ing ‘‘, and counseling for cessation of tobacco use by 

5 pregnant women (as defined in section 1905(y))’’ 

6 after ‘‘complicate the pregnancy’’. 

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

8 this section shall apply to services furnished on or after 

9 the date that is 1 year after the date of enactment of this 

10 Act. 

11 SEC. 5. STATE OPTION TO PROVIDE FAMILY PLANNING 

12 SERVICES AND SUPPLIES TO INDIVIDUALS 

13 WITH INCOMES THAT DO NOT EXCEED A 

14 STATE’S INCOME ELIGIBILITY LEVEL FOR 

15 MEDICAL ASSISTANCE. 

16 (a) IN GENERAL.—Title XIX of the Social Security 

17 Act (42 U.S.C. 1396 et seq.) is amended— 

18 (1) by redesignating section 1939 as section 

19 1940; and 

20 (2) by inserting after section 1938 the following 

21 new section: 

22 ‘‘STATE OPTION TO PROVIDE FAMILY PLANNING

23 SERVICES AND SUPPLIES

24 ‘‘SEC. 1939. (a) IN GENERAL.—Subject to sub25 sections (b) and (c), a State may elect (through a State 

26 plan amendment) to make medical assistance described in 


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1 section 1905(a)(4)(C) available to any individual whose 

2 family income does not exceed the greater of— 

3 ‘‘(1) 185 percent of the income official poverty 

4 line (as defined by the Office of Management and 

5 Budget, and revised annually in accordance with sec6 tion 673(2) of the Omnibus Budget Reconciliation 

7 Act of 1981) applicable to a family of the size in8 volved; or 

9 ‘‘(2) the eligibility income level (expressed as a 

10 percentage of such poverty line) that has been speci11 fied under a waiver authorized by the Secretary or 

12 under section 1902(r)(2)), on October 1, 2007, for 

13 an individual to be eligible for medical assistance 

14 under the State plan. 

15 ‘‘(b) COMPARABILITY.—Medical assistance described 

16 in section 1905(a)(4)(C) that is made available under a 

17 State plan amendment under subsection (a) shall— 

18 ‘‘(1) not be less in amount, duration, or scope 

19 than the medical assistance described in that section 

20 that is made available to any other individual under 

21 the State plan; and 

22 ‘‘(2) be provided in accordance with the restric23 tions on deductions, cost sharing, or similar charges 

24 imposed under section 1916(a)(2)(D). 


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1 ‘‘(c) OPTION TO EXTEND COVERAGE DURING A

2 POST-ELIGIBILITY PERIOD.— 

3 ‘‘(1) INITIAL PERIOD.—A State plan amend4 ment made under subsection (a) may provide that 

5 any individual who was receiving medical assistance 

6 described in section 1905(a)(4)(C) as a result of 

7 such amendment, and who becomes ineligible for 

8 such assistance because of hours of, or income from, 

9 employment, may remain eligible for such medical 

10 assistance through the end of the 6-month period 

11 that begins on the first day the individual becomes 

12 so ineligible. 

13 ‘‘(2) ADDITIONAL EXTENSION.—A State plan 

14 amendment made under subsection (a) may provide 

15 that any individual who has received medical assist16 ance described in section 1905(a)(4)(C) during the 

17 entire 6-month period described in paragraph (1) 

18 may be extended coverage for such assistance for a 

19 succeeding 6-month period.’’. 

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

21 subsection (a) apply to medical assistance provided on and 

22 after October 1, 2007. 


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1 SEC. 6. STATE OPTION TO EXTEND THE POSTPARTUM PE2 RIOD FOR PROVISION OF FAMILY PLANNING 

3 SERVICES AND SUPPLIES. 

4 (a) IN GENERAL.—Section 1902(e)(5) of the Social 

5 Security Act (42 U.S.C. 1396a(e)(5)) is amended— 

6 (1) by striking ‘‘eligible under the plan, as 

7 though’’ and inserting ‘‘eligible under the plan— 

8 ‘‘(A) as though’’; 

9 (2) by striking the period and inserting ‘‘; 

10 and’’; and 

11 (3) by adding at the end the following new sub12 paragraph: 

13 ‘‘(B) for medical assistance described in section 

14 1905(a)(4)(C) for so long as the family income of 

15 such woman does not exceed the maximum income 

16 level established by the State for the woman to be 

17 eligible for medical assistance under the State plan 

18 (as a result of pregnancy or otherwise).’’. 

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

20 subsection (a) apply to medical assistance provided on and 

21 after October 1, 2007. 

22 SEC. 7. STATE OPTION TO PROVIDE SUPPLEMENTAL SCHIP 

23 COVERAGE TO CHILDREN WHO HAVE OTHER 

24 HEALTH COVERAGE. 

25 (a) IN GENERAL.— 

26 (1) SCHIP.— 


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1 (A) STATE OPTION TO PROVIDE SUPPLE2 MENTAL COVERAGE.—Section 2110(b) of the 

3 Social Security Act (42 U.S.C. 1397jj(b)) is 

4 amended— 

5 (i) in paragraph (1)(C), by inserting 

6 ‘‘, subject to paragraph (5),’’ after ‘‘under 

7 title XIX or’’; and 

8 (ii) by adding at the end the fol9 lowing: 

10 ‘‘(5) STATE OPTION TO PROVIDE SUPPLE11 MENTAL COVERAGE.— 

12 ‘‘(A) IN GENERAL.—A State may waive 

13 the requirement of paragraph (1)(C) that a tar14 geted low-income child may not be covered 

15 under a group health plan or under health in16 surance coverage if the State satisfies the con17 ditions described in subsection (c)(9). The State 

18 may waive such requirement in order to pro19 vide— 

20 ‘‘(i) services for children with special 

21 health care needs (as defined for purposes 

22 of title V); or 

23 ‘‘(ii) all services. 

24 ‘‘(B) AUTHORITY TO LIMIT INCOME ELIGI25 BILITY.—In waiving such requirement, a State 


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1 may limit the application of the waiver to chil2 dren whose family income does not exceed a 

3 level specified by the State, so long as the level 

4 so specified does not exceed the maximum in5 come level otherwise established for other chil6 dren under the State child health plan.’’. 

7 (B) CONDITIONS DESCRIBED.—Section 

8 2105(c) of the Social Security Act (42 U.S.C. 

9 1397ee(c)) is amended by adding at the end the 

10 following: 

11 ‘‘(9) CONDITIONS FOR PROVISION OF SUPPLE12 MENTAL COVERAGE.—For purposes of section 

13 2110(b)(5), the conditions described in this para14 graph are the following: 

15 ‘‘(A) INCOME ELIGIBILITY.—The State 

16 child health plan (whether implemented under 

17 title XIX or this title)— 

18 ‘‘(i) has the highest income eligibility 

19 standard permitted under this title on Jan20 uary 1, 2008; 

21 ‘‘(ii) subject to subparagraph (B), 

22 does not limit the acceptance of applica23 tions for children; and 


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1 ‘‘(iii) provides benefits to all children 

2 in the State who apply for and meet eligi3 bility standards. 

4 ‘‘(B) NO WAITING LIST IMPOSED.—With 

5 respect to children whose family income is at or 

6 below 200 percent of the poverty line, the State 

7 does not impose any numerical limitation, wait8 ing list, or similar limitation on the eligibility of 

9 such children for child health assistance under 

10 such State plan. 

11 ‘‘(C) NO MORE FAVORABLE TREATMENT.— 

12 The State child health plan may not provide 

13 more favorable coverage of dental services to 

14 the children covered under section 2110(b)(5) 

15 than to children otherwise covered under this 

16 title.’’. 

17 (C) STATE OPTION TO WAIVE WAITING PE18 RIOD.—Section 2102(b)(1)(B) of the Social Se19 curity Act (42 U.S.C. 1397bb(b)(1)(B)), as 

20 amended by section 2(b)(3)(B), is amended— 

21 (i) in clause (ii), by striking ‘‘and’’ at 

22 the end; 

23 (ii) in clause (iii), by striking the pe24 riod at the end and inserting ‘‘; and’’; and 


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1 (iii) by adding at the end the fol2 lowing new clause: 

3 ‘‘(iv) at State option, may not apply a 

4 waiting period in the case of a child de5 scribed in section 2110(b)(5), if the State 

6 satisfies the requirements of section 

7 2105(c)(9).’’. 

8 (2) APPLICATION OF ENHANCED MATCH UNDER

9 MEDICAID.—Section 1905 of the Social Security Act 

10 (42 U.S.C. 1396d), as amended by section 2(a)(2), 

11 is amended— 

12 (A) in subsection (b), in the fourth sen13 tence, by striking ‘‘or (u)(4)’’ and inserting 

14 ‘‘(u)(4), or (u)(5)’’; and 

15 (B) in subsection (u)— 

16 (i) by redesignating paragraph (5) as 

17 paragraph (6); and 

18 (ii) by inserting after paragraph (4) 

19 the following: 

20 ‘‘(5) For purposes of subsection (b), the ex21 penditures described in this paragraph are expendi22 tures for items and services for children described in 

23 section 2110(b)(5), but only in the case of a State 

24 that satisfies the requirements of section 

25 2105(c)(8).’’. 


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1 (3) APPLICATION OF SECONDARY PAYOR PROVI2 SIONS.—Section 2107(e)(1) of the Social Security 

3 Act (42 U.S.C. 1397gg(e)(1)), as amended by sec4 tion 3(b), is amended by adding at the end the fol5 lowing: 

6 ‘‘(F) Section 1902(a)(25) (relating to co7 ordination of benefits and secondary payor pro8 visions) with respect to children covered under 

9 a waiver described in section 2110(b)(5).’’. 

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

11 subsection (a) shall take effect on January 1, 2008, and 

12 shall apply to child health assistance and medical assist13 ance provided on or after that date. 

14 SEC. 8. DEMONSTRATION PROJECT FOR COVERAGE OF 

15 TELEMEDICINE SERVICES UNDER MEDICAID. 

16 (a) DEFINITIONS.— 

17 (1) APPLICABLE INDIVIDUAL.—The term ‘‘ap18 plicable individual’’ means an individual who— 

19 (A) is eligible for benefits under a State 

20 plan under title XIX of the Social Security Act 

21 (42 U.S.C. 1396 et seq.); 

22 (B) is a pregnant woman; 

23 (C) is at risk of complications in preg24 nancy or preterm birth; and 

25 (D) resides in a rural area. 


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1 (2) MEDICAID.—The term ‘‘Medicaid’’ means 

2 the program established under title XIX of the So3 cial Security Act (42 U.S.C. 1396 et seq.). 

4 (3) RURAL AREA.—The term ‘‘rural area’’ 

5 means an area not within a Metropolitan Statistical 

6 Area (as defined by the Office of Management and 

7 Budget). 

8 (4) SECRETARY.—The term ‘‘Secretary’’ means 

9 the Secretary of Health and Human Services. 

10 (5) STATE.—The term ‘‘State’’ has the mean11 ing given such term for purposes of title XIX of the 

12 Social Security Act (42 U.S.C. 1396 et seq.). 

13 (6) TELEMEDICINE SERVICES.—The term ‘‘tele14 medicine services’’ means the provision of health 

15 care consultations and diagnoses by an off-site spe16 cialist using equipment that allows the specialist to 

17 be connected to a local provider and a patient in real 

18 time during a patient visit. 

19 (b) ESTABLISHMENT.— 

20 (1) IN GENERAL.—The Secretary shall establish 

21 a demonstration program (in this section referred to 

22 as the ‘‘program’’) to provide payments to States for 

23 the cost of providing telemedicine services for the 

24 treatment of applicable individuals. 

25 (2) SITES.— 


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1 (A) IN GENERAL.—The demonstration 

2 shall be conducted at not less than 3 and not 

3 more than 5 sites. 

4 (B) COMPOSITION.—Each site shall be 

5 composed of a single rural area. 

6 (3) DURATION.—The demonstration shall be 

7 conducted for a period of 3 years. 

8 (c) USE OF FUNDS.—Funds provided to a State 

9 under the program shall be used to reimburse local pro10 viders and off-site specialists for the cost of providing tele11 medicine services for the treatment of applicable individ12 uals. 

13 (d) EVALUATIONS AND REPORTS.— 

14 (1) INITIAL EVALUATION AND REPORT.—Not 

15 later than 24 months after the date of enactment of 

16 this Act, the Secretary shall provide to Congress an 

17 interim report on the demonstration containing an 

18 evaluation of the impact of the demonstration on 

19 health outcomes and cost-effectiveness. 

20 (2) FINAL REPORT.—Not later than 6 months 

21 after the completion of the program under this sec22 tion, the Secretary shall submit to Congress a report 

23 on such program, together with recommendations for 

24 such legislation and administrative action as the 

25 Secretary determines to be appropriate. 


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1 (e) PROHIBITION.—Amounts paid to a State under 

2 the program shall not be used for purposes of claiming 

3 a Federal matching payment under section 1903(a) of the 

4 Social Security Act (42 U.S.C. 1396b(a)). 

5 (f) LIMITATION ON PAYMENT AMOUNTS.—In no case 

6 may the aggregate amount paid by the Secretary to States 

7 under the program exceed $15,000,000. 

8 (g) WAIVER.—The Secretary shall waive compliance 

9 with such requirements of the Medicaid program to the 

10 extent and for the period the Secretary finds necessary 

11 to conduct the program. 

12 SEC. 9. PEDIATRIC AND PERINATAL QUALITY MEASURES. 

13 (a) PEDIATRIC AND PERINATAL QUALITY MEAS14 URES.— 

15 (1) IN GENERAL.—The Secretary of Health and 

16 Human Services (in this section referred to as the 

17 ‘‘Secretary’’) shall develop and disseminate a na18 tional set of core pediatric and perinatal quality 

19 measures. 

20 (2) CONSULTATION AND COLLABORATION.— 

21 (A) COLLABORATION.—In developing and 

22 disseminating such quality measures, the Sec23 retary shall collaborate with— 

24 (i) the Director of the Agency for 

25 Healthcare Research and Quality; and 


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1 (ii) other appropriate entities, includ2 ing— 

3 (I) a national organization that 

4 exists for the purpose of achieving 

5 consensus among health care pro6 viders, payers, and consumers on rec7 ommendations of measures of quality; 

8 and 

9 (II) health professional certifi10 cation boards. 

11 (B) CONSULTATION.—In developing and 

12 disseminating such quality measures, the Sec13 retary shall consult with— 

14 (i) health professionals; and 

15 (ii) consumer groups. 

16 (3) APPROPRIATION.—There are appropriated 

17 $50,000,000 to the Agency for Healthcare Research 

18 and Quality for each of fiscal years 2009, 2010, and 

19 2011, to carry out this subsection. 

20 (b) COLLECTION AND REPORTING OF STATE

21 DATA.— 

22 (1) IN GENERAL.—The Secretary shall collect 

23 data regarding the extent to which States use pedi24 atric and perinatal inpatient and outpatient quality 

25 measures on an ongoing basis. 


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1 (2) REPORT.—The Secretary shall report to 

2 Congress and make publicly available the data col3 lected under paragraph (1) on an annual basis. 

4 (c) REQUIREMENT UNDER STATE PLAN.— 

5 (1) MEDICAID.—Section 1902(a) of the Social 

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

7 (A) in paragraph (69), by striking ‘‘and’’; 

8 (B) in paragraph (70), by striking the pe9 riod at the end and inserting ‘‘; and’’; and 

10 (C) by inserting after paragraph (70) the 

11 following new paragraph: 

12 ‘‘(71) provide that the State shall cooperate 

13 with the Secretary in the collection of data under 

14 section 9(b)(1) of the Prevent Prematurity and Im15 prove Child Health Act of 2007.’’. 

16 (2) SCHIP.—Section 2107(e)(1) of the Social 

17 Security Act (42 U.S.C. 1397gg(e)(1)) is amended 

18 by adding at the end the following new subpara19 graph: 

20 ‘‘(E) Section 1902(a)(71) (relating to col21 lection of data).’’. 

22 (d) PAYMENTS TO STATES FOR IMPLEMENTATION OF

23 QUALITY MEASURES.— 


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1 (1) MEDICAID.—Section 1903(a)(3) of the So2 cial Security Act (42 U.S.C. 1396b(a)(3)) is amend3 ed— 

4 (A) in subparagraph (D), by striking 

5 ‘‘and’’; 

6 (B) in subparagraph (E)(ii), by striking 

7 ‘‘plus’’ and inserting ‘‘and’’; and 

8 (C) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(F) an amount equal to the enhanced 

11 FMAP (as defined in section 2105(b)) of the 

12 sums expended during the quarter which are at13 tributable to the costs of complying with section 

14 1902(a)(71); plus’’. 

15 (2) SCHIP.—Section 2105(a)(1)(D) of the So16 cial Security Act (42 U.S.C. 1397ee(a)(1)(D)) is 

17 amended— 

18 (A) in clause (iii), by striking ‘‘and’’; 

19 (B) by redesignating clause (iv) as clause 

20 (v); and 

21 (C) by inserting after clause (iii) the fol22 lowing new clause: 


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1 ‘‘(iv) for expenditures attributable to 

2 the costs of complying with section 

3 2107(e)(1)(E); and’’. 

Æ 


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