I
105TH CONGRESS
2D SESSION
H. R. 3779
To amend title XIX of the Social Security Act to provide medical assistance
for breast and cervical cancer-related treatment services to certain women
screened and found to have breast or cervical cancer under a Federally
funded screening program.
IN THE HOUSE OF REPRESENTATIVES
APRIL 30, 1998
Mr. LAZIO of New York (for himself and Mrs. KENNELLY of Connecticut) in-
troduced the following bill; which was referred to the Committee on Com-
merce
A BILL
To amend title XIX of the Social Security Act to provide
medical assistance for breast and cervical cancer-related
treatment services to certain women screened and found
to have breast or cervical cancer under a Federally fund-
ed screening program.
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 ‘‘Breast and Cervical
Cancer Treatment Act of 1998’’.
SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN
BREAST OR CERVICAL CANCER PATIENTS.
(a) 
COVERAGE
AS
OPTIONAL
CATEGORICALLY
NEEDY GROUP.—Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amend-
ed—
(1) in subclause (XIII), by striking ‘‘or’’ at the
end;
(2) in subclause (XIV), by adding ‘‘or’’ at the
end; and
(3) by adding at the end the following:
‘‘(XV) who are described in sub-
section (aa)(1) (relating to certain
breast or cervical cancer patients);’’.
(b) GROUP
AND
BENEFIT
DESCRIBED.—Section
1902 of the Social Security Act (42 U.S.C. 1396a) is
amended by adding at the end the following:
‘‘(aa)(1) Individuals described in this paragraph are
individuals who—
‘‘(A) 
are 
not 
described 
in 
subsection
(a)(10)(A)(i);
‘‘(B) have not attained age 65;
‘‘(C) satisfy income and resource requirements
to be treated as a low-income woman for purposes
of being given priority under section 1504 of the
Public Health Service Act (42 U.S.C. 300n); and
‘‘(D) are not otherwise covered under creditable
coverage, as defined in section 2701(c) of the Public
Health Service Act (45 U.S.C. 300gg(c)).
‘‘(2) For purposes of this title, the term ‘breast or
cervical cancer-related treatment services’ means services
that are medically necessary or appropriate for the treat-
ment of breast or cervical cancer and complications arising
from such treatment and for which medical assistance is
made available under the State plan to individuals de-
scribed in subsection (a)(10)(A)(i).’’.
(c) PRESUMPTIVE ELIGIBILITY.—
(1) IN GENERAL.—Title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) is amended by
inserting after section 1920A the following:
‘‘PRESUMPTIVE ELIGIBILITY FOR CERTAIN BREAST OR
CERVICAL CANCER PATIENTS
‘‘SEC. 1920B. (a) STATE OPTION.—A State plan ap-
proved under section 1902 may provide for making medi-
cal assistance for breast or cervical cancer-related treat-
ment services available to an individual described in sec-
tion 1902(aa)(1) (relating to certain breast or cervical
cancer patients) during a presumptive eligibility period.
‘‘(b) DEFINITIONS.—For purposes of this section:
‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The
term ‘presumptive eligibility period’ means, with re-
spect to an individual described in subsection (a),
the period that—
‘‘(A) begins with the date on which a
qualified entity determines, on the basis of pre-
liminary information, that the individual is de-
scribed in section 1902(aa)(1), and
‘‘(B) ends with (and includes) the earlier
of—
‘‘(i) the day on which a determination
is made with respect to the eligibility of
such individual for services under the State
plan, or
‘‘(ii) in the case of such an individual
who does not file an application by the last
day of the month following the month dur-
ing which the entity makes the determina-
tion referred to in subparagraph (A), such
last day.
‘‘(2) QUALIFIED ENTITY.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘qualified entity’ means
any entity that—
‘‘(i) is eligible for payments under a
State plan approved under this title and
provides breast or cervical cancer-related
treatment services; and
‘‘(ii) is determined by the State agen-
cy to be capable of making determinations
of the type described in paragraph (1)(A).
‘‘(B) REGULATIONS.—The Secretary may
issue regulations further limiting those entities
that may become qualified entities in order to
prevent fraud and abuse and for other reasons.
‘‘(C) RULE OF CONSTRUCTION.—Nothing
in this paragraph shall be construed as prevent-
ing a State from limiting the classes of entities
that may become qualified entities, consistent
with any limitations imposed under subpara-
graph (B).
‘‘(c) ADMINISTRATION.—
‘‘(1) IN GENERAL.—The State agency shall pro-
vide qualified entities with—
‘‘(A) such forms as are necessary for an
application to be made by an individual de-
scribed in subsection (a) for medical assistance
under the State plan, and
‘‘(B) information on how to assist such in-
dividuals in completing and filing such forms.
‘‘(2) NOTIFICATION REQUIREMENTS.—A quali-
fied 
entity 
that 
determines 
under 
subsection
(b)(1)(A) that an individual described in subsection
(a) is presumptively eligible for medical assistance
for breast or cervical cancer-related treatment serv-
ices under a State plan shall—
‘‘(A) notify the State agency of the deter-
mination within 5 working days after the date
on which determination is made, and
‘‘(B) inform such individual at the time
the determination is made that an application
for medical assistance under the State plan is
required to be made by not later than the last
day of the month following the month during
which the determination is made.
‘‘(3) 
APPLICATION
FOR
MEDICAL
ASSIST-
ANCE.—In the case of an individual described in
subsection (a) who is determined by a qualified en-
tity to be presumptively eligible for medical assist-
ance for breast or cervical cancer-related treatment
services under a State plan, the individual shall
apply for medical assistance under such plan by not
later than the last day of the month following the
month during which the determination is made.
‘‘(d) PAYMENT.—Notwithstanding any other provi-
sion of this title, medical assistance for breast or cervical
cancer-related treatment services that—
‘‘(1) are furnished to an individual described in
subsection (a)—
‘‘(A) during a presumptive eligibility pe-
riod,
‘‘(B) by an entity that is eligible for pay-
ments under the State plan; and
‘‘(2) are included in the care and services cov-
ered by the State plan;
shall be treated as medical assistance provided by such
plan for purposes of section 1903(a)(5)(B).’’.
(2) PRESUMPTIVE
ELIGIBILITY
CONFORMING
AMENDMENTS.—
(A) Section 1902(a)(47) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(47)) is amend-
ed by inserting before the semicolon at the end
the following: ‘‘and provide for making medical
assistance for breast or cervical cancer-related
treatment services available to individuals de-
scribed in subsection (a) of section 1920B dur-
ing a presumptive eligibility period in accord-
ance with such section’’.
(B) Section 1903(u)(1)(D)(v) of such Act
(42 U.S.C. 1396b(u)(1)(D)(v)) is amended—
(i) by striking ‘‘or for’’ and inserting
‘‘, for’’; and
(ii) by inserting before the period the
following: ‘‘, or for medical assistance for
breast or cervical cancer-related treatment
services provided to an individual described
in subsection (a) of section 1920B during
a presumptive eligibility period under such
section’’.
(d) ENHANCED MATCH.—Section 1903(a)(5) of the
Social Security Act (42 U.S.C. 1396b(a)(5)) is amended—
(1) by striking ‘‘an’’ and inserting ‘‘(A) an’’;
(2) by adding ‘‘plus’’ after the semicolon; and
(3) by adding at the end the following:
‘‘(B) an amount equal to 75 percent of the
sums expended during such quarter which are at-
tributable to the offering, arranging, and furnishing
(directly or on a contract basis) of breast or cervical
cancer-related treatment services; plus’’.
(e) LIMITATION ON BENEFITS.—Section 1902(a)(10)
of the Social Security Act (42 U.S.C. 1396a(a)(10)) is
amended in the matter following subparagraph (F)—
(1) by striking ‘‘and (XIII)’’ and inserting
‘‘(XIII)’’; and
(2) by inserting before the semicolon at the end
the following: ‘‘, and (XIV) the medical assistance
made available to an individual described in sub-
section (aa)(1) who is eligible for medical assistance
only because of subparagraph (A)(ii)(XV) shall be
limited to medical assistance for breast or cervical
cancer-related treatment services’’.
(f) CONFORMING AMENDMENTS.—Section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) is amended
in the matter preceding paragraph (1)—
(1) in clause (x), by striking ‘‘or’’ at the end;
(2) in clause (xi), by adding ‘‘or’’ at the end;
and
(3) by inserting after clause (xi) the following:
‘‘(xii) 
individuals 
described 
in 
section
1902(aa)(1),’’.
(g) EFFECTIVE DATE.—The amendments made by
this section apply to medical assistance furnished on or
after October 1, 1998, without regard to whether or not
final regulations to carry out such amendments have been
promulgated by such date.
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