I 

111TH CONGRESS 

1ST SESSION H. R. 2952 

To amend title XIX of the Social Security Act to provide medical assistance 

for certain men screened and found to have prostate cancer under a 

federally funded screening program. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 18, 2009 

Ms. NORTON 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 provide 

medical assistance for certain men screened and found 

to have prostate cancer under a federally funded screening program. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicaid Prostate 

5 Cancer Coverage Act of 2009’’. 


tjames on PRODPC75 with BILLS
2 

•HR 2952 IH

1 SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN 

2 PROSTATE CANCER PATIENTS. 

3 (a) COVERAGE AS OPTIONAL CATEGORICALLY

4 NEEDY GROUP.— 

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

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

7 1396a(a)(10)(A)(ii)) is amended— 

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

9 at the end; 

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

11 the end; and 

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

13 ‘‘(XX) who are described in sub14 section (gg) (relating to certain pros15 tate cancer patients);’’. 

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

17 Act (42 U.S.C. 1396a) is amended by adding at the 

18 end the following: 

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

21 ‘‘(1) are not described in subsection 

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

23 ‘‘(2) have not attained age 65; 

24 ‘‘(3) have been screened for prostate cancer 

25 under section 317D of the Public Health Service Act 

26 (42 U.S.C. 247b–5), or any other prostate cancer 


tjames on PRODPC75 with BILLS
3 

•HR 2952 IH

1 screening program supported with Federal funds, 

2 and need treatment for prostate cancer; 

3 ‘‘(4) are in families whose income does not ex4 ceed 250 percent of the income official poverty line 

5 (as defined by the Office of Management and Budg6 et, and revised annually in accordance with section 

7 673(2) of the Omnibus Budget Reconciliation Act of 

8 1981) applicable to a family of the size involved; and 

9 ‘‘(5) are not otherwise covered under creditable 

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

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

12 (3) LIMITATION ON BENEFITS.—Section 

13 1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10)) 

14 is amended in the matter following subparagraph 

15 (G)— 

16 (A) by striking ‘‘and (XIV)’’ and inserting 

17 ‘‘(XIV)’’; and 

18 (B) by inserting ‘‘, and (XV) the medical 

19 assistance made available to an individual de20 scribed in subsection (aa) who is eligible for 

21 medical assistance only because of subpara22 graph (A)(10)(ii)(XX) shall be limited to med23 ical assistance provided during the period in 

24 which such an individual requires treatment for 

25 prostate cancer’’ before the semicolon. 


tjames on PRODPC75 with BILLS
4 

•HR 2952 IH

1 (4) CONFORMING AMENDMENTS.—Section 

2 1905(a) of the Social Security Act (42 U.S.C. 

3 1396d(a)) is amended in the matter preceding para4 graph (1)— 

5 (A) in clause (xii), by striking ‘‘or’’ at the 

6 end; 

7 (B) in clause (xiii), by adding ‘‘or’’ at the 

8 end; and 

9 (C) by inserting after clause (xiii) the fol10 lowing: 

11 ‘‘(xiv) individuals described in section 

12 1902(gg),’’. 

13 (b) PRESUMPTIVE ELIGIBILITY.— 

14 (1) IN GENERAL.—Title XIX of the Social Se15 curity Act (42 U.S.C. 1396 et seq.) is amended by 

16 inserting after section 1920B the following: 

17 ‘‘PRESUMPTIVE ELIGIBILITY FOR CERTAIN PROSTATE

18 CANCER PATIENTS

19 ‘‘SEC. 1920C. (a) STATE OPTION.—A State plan ap20 proved under section 1902 may provide for making med21 ical assistance available to an individual described in sec22 tion 1902(gg) (relating to certain prostate cancer pa23 tients) during a presumptive eligibility period. 

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

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

26 term ‘presumptive eligibility period’ means, with reVerDate Nov 24 2008 06:04 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2952.IH H2952

tjames on PRODPC75 with BILLS
5 

•HR 2952 IH

1 spect to an individual described in subsection (a), 

2 the period that— 

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

4 qualified entity determines, on the basis of pre5 liminary information, that the individual is de6 scribed in section 1902(gg); and 

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

8 of— 

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

10 is made with respect to the eligibility of 

11 such individual for services under the State 

12 plan; or 

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

14 who does not file an application by the last 

15 day of the month following the month dur16 ing which the entity makes the determina17 tion referred to in subparagraph (A), such 

18 last day. 

19 ‘‘(2) QUALIFIED ENTITY.— 

20 ‘‘(A) IN GENERAL.—Subject to subpara21 graph (B), the term ‘qualified entity’ means 

22 any entity that— 

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

24 State plan approved under this title; and 


tjames on PRODPC75 with BILLS
6 

•HR 2952 IH

1 ‘‘(ii) is determined by the State agen2 cy to be capable of making determinations 

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

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

5 issue regulations further limiting those entities 

6 that may become qualified entities in order to 

7 prevent fraud and abuse and for other reasons. 

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

9 in this paragraph shall be construed as pre10 venting a State from limiting the classes of en11 tities that may become qualified entities, con12 sistent with any limitations imposed under sub13 paragraph (B). 

14 ‘‘(c) ADMINISTRATION.— 

15 ‘‘(1) IN GENERAL.—The State agency shall pro16 vide qualified entities with— 

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

18 application to be made by an individual de19 scribed in subsection (a) for medical assistance 

20 under the State plan; and 

21 ‘‘(B) information on how to assist such in22 dividuals in completing and filing such forms. 

23 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali24 fied entity that determines under subsection 

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


tjames on PRODPC75 with BILLS
7 

•HR 2952 IH

1 (a) is presumptively eligible for medical assistance 

2 under a State plan shall— 

3 ‘‘(A) notify the State agency of the deter4 mination within 5 working days after the date 

5 on which determination is made; and 

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

7 the determination is made that an application 

8 for medical assistance under the State plan is 

9 required to be made by not later than the last 

10 day of the month following the month during 

11 which the determination is made. 

12 ‘‘(3) APPLICATION FOR MEDICAL ASSIST13 ANCE.—In the case of an individual described in 

14 subsection (a) who is determined by a qualified enti15 ty to be presumptively eligible for medical assistance 

16 under a State plan, the individual shall apply for 

17 medical assistance under such plan by not later than 

18 the last day of the month following the month dur19 ing which the determination is made. 

20 ‘‘(d) PAYMENT.—Notwithstanding any other provi21 sion of this title, medical assistance that— 

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

23 subsection (a)— 

24 ‘‘(A) during a presumptive eligibility pe25 riod; and 


tjames on PRODPC75 with BILLS
8 

•HR 2952 IH

1 ‘‘(B) by a entity that is eligible for pay2 ments under the State plan; and 

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

4 by the State plan; 

5 shall be treated as medical assistance provided by such 

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

7 (2) CONFORMING AMENDMENTS.— 

8 (A) Section 1902(a)(47) of the Social Se9 curity Act (42 U.S.C. 1396a(a)(47)) is amend10 ed— 

11 (i) by striking ‘‘and provide’’ and in12 serting ‘‘, provide’’; and 

13 (ii) by inserting before the semicolon 

14 at the end the following: ‘‘, and provide for 

15 making medical assistance available to in16 dividuals described in subsection (a) of sec17 tion 1920C during a presumptive eligibility 

18 period in accordance with such section’’. 

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

20 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended— 

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

22 ‘‘, for’’; and 

23 (ii) by inserting before the period the 

24 following: ‘‘, or for medical assistance pro25 vided to an individual described in subVerDate Nov 24 2008 06:04 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2952.IH H2952

tjames on PRODPC75 with BILLS
9 

•HR 2952 IH

1 section (a) of section 1920C during a pre2 sumptive eligibility period under such sec3 tion’’. 

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

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

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

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

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

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

10 sums expended during such quarter which are at11 tributable to the offering, arranging, and furnishing 

12 (directly or on a contract basis) of prostate cancer13 related treatment services; plus’’. 

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

15 this section apply to medical assistance furnished on or 

16 after the date of the enactment of this Act, without regard 

17 to whether final regulations to carry out such amendments 

18 have been promulgated by such date. 

Æ 


tjames on PRODPC75 with BILLS