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107TH CONGRESS

1ST SESSION H. R. 1793

To amend title XIX of the Social Security Act to permit a State waiver

authority to provide medical assistance in cases of congenital heart defects.

IN THE HOUSE OF REPRESENTATIVES

MAY 10, 2001

Mrs. MORELLA (for herself, Mr. WYNN, and Mr. PUTNAM) introduced the

following bill; which was referred to the Committee on Energy and Commerce

A BILL

To amend title XIX of the Social Security Act to permit

a State waiver authority to provide medical assistance

in cases of congenital heart defects.

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 ‘‘Melissa Froelich Med5 icaid Congenital Heart Defect Waiver Act of 2001’’.

6 SEC. 2. MEDICAID WAIVER TO PROVIDE MEDICAL ASSIST7 ANCE IN CASE OF INDIVIDUALS WITH CON8 GENITAL HEART DEFECTS.

9 Section 1915 of the Social Security Act (42 U.S.C.

10 1396n) is amended—
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1 (1) by redesignating subsection (h) as sub2 section (i); and

3 (2) by inserting after subsection (g) the fol4 lowing new subsection:

5 ‘‘(h)(1)(A) Subject to paragraph (2), the Secretary

6 shall by waiver provide that a State plan approved under

7 this title may include as ‘medical assistance’ under such

8 plan payment for part or all of the costs of nursing care

9 (including home health nursing care), respite care, physi10 cians’ services, prescribed drugs (including physician or11 dered dietary supplements), medical devices and supplies,

12 home modifications required to accommodate the indi13 vidual, transportation services (including medical trans14 port costs of life-saving flights to treating hospitals as well

15 as transportation to access highly specialized care which

16 does not exist in the area of residence), payment for the

17 set aside fund for placement on the National Organ Wait18 ing List, and such other services related to the treatment

19 of the congenital heart defect or defects requested by the

20 State as the Secretary may approve which are provided

21 pursuant to a written plan of care to an individual de22 scribed in subparagraph (B). Such payment shall be made

23 (in a manner consistent with section 1902(a)(25)) for

24 costs of covered benefits that are not reimbursed under
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1 group health plan, other insurance coverage, or other third

2 party liability.

3 ‘‘(B) Individuals described in this subparagraph are

4 individuals who at the time of birth had one or more con5 genital heart defects which require surgical intervention.

6 ‘‘(2) A waiver shall not be granted under this sub7 section unless the State provides assurances satisfactory

8 to the Secretary that—

9 ‘‘(A) necessary safeguards (including adequate

10 standards for provider participation) have been

11 taken to protect the health and welfare of individ12 uals provided services under the waiver and to as13 sure financial accountability for funds expended with

14 respect to such services;

15 ‘‘(B) under such waiver, the State, in any fiscal

16 year will be the secondary payor of the medical as17 sistance as required under section 1902(a)(25);

18 ‘‘(C) individuals described in paragraph (1)(B)

19 shall be eligible for medical assistance at the time

20 they have exhausted (either on a lifetime basis or

21 based upon an annual limitation on benefits) all

22 other health insurance benefits, without regard to

23 the assets or resources of the individual or the indi24 vidual’s family;
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1 ‘‘(D) the State will provide to the Secretary an2 nually, consistent with a data collection plan de3 signed by the Secretary, information on the impact

4 of the waiver granted under this subsection on the

5 type and amount of medical assistance provided

6 under the State plan and on the health and welfare

7 of recipients.

8 ‘‘(3) The provisions of paragraphs (3) and (4) of sub9 section (e) shall apply under this subsection in the same

10 manner as they apply under such subsection.’’.

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