I
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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Melissa Froelich Med-
icaid Congenital Heart Defect Waiver Act of 2001’’.
SEC. 2. MEDICAID WAIVER TO PROVIDE MEDICAL ASSIST-
ANCE IN CASE OF INDIVIDUALS WITH CON-
GENITAL HEART DEFECTS.
Section 1915 of the Social Security Act (42 U.S.C.
1396n) is amended—
(1) by redesignating subsection (h) as sub-
section (i); and
(2) by inserting after subsection (g) the fol-
lowing new subsection:
‘‘(h)(1)(A) Subject to paragraph (2), the Secretary
shall by waiver provide that a State plan approved under
this title may include as ‘medical assistance’ under such
plan payment for part or all of the costs of nursing care
(including home health nursing care), respite care, physi-
cians’ services, prescribed drugs (including physician or-
dered dietary supplements), medical devices and supplies,
home modifications required to accommodate the indi-
vidual, transportation services (including medical trans-
port costs of life-saving flights to treating hospitals as well
as transportation to access highly specialized care which
does not exist in the area of residence), payment for the
set aside fund for placement on the National Organ Wait-
ing List, and such other services related to the treatment
of the congenital heart defect or defects requested by the
State as the Secretary may approve which are provided
pursuant to a written plan of care to an individual de-
scribed in subparagraph (B). Such payment shall be made
(in a manner consistent with section 1902(a)(25)) for
costs of covered benefits that are not reimbursed under
group health plan, other insurance coverage, or other third
party liability.
‘‘(B) Individuals described in this subparagraph are
individuals who at the time of birth had one or more con-
genital heart defects which require surgical intervention.
‘‘(2) A waiver shall not be granted under this sub-
section unless the State provides assurances satisfactory
to the Secretary that—
‘‘(A) necessary safeguards (including adequate
standards for provider participation) have been
taken to protect the health and welfare of individ-
uals provided services under the waiver and to as-
sure financial accountability for funds expended with
respect to such services;
‘‘(B) under such waiver, the State, in any fiscal
year will be the secondary payor of the medical as-
sistance as required under section 1902(a)(25);
‘‘(C) individuals described in paragraph (1)(B)
shall be eligible for medical assistance at the time
they have exhausted (either on a lifetime basis or
based upon an annual limitation on benefits) all
other health insurance benefits, without regard to
the assets or resources of the individual or the indi-
vidual’s family;
‘‘(D) the State will provide to the Secretary an-
nually, consistent with a data collection plan de-
signed by the Secretary, information on the impact
of the waiver granted under this subsection on the
type and amount of medical assistance provided
under the State plan and on the health and welfare
of recipients.
‘‘(3) The provisions of paragraphs (3) and (4) of sub-
section (e) shall apply under this subsection in the same
manner as they apply under such subsection.’’.
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