813
Title IV, Subtitle C
‘‘(ii) in the case of an unmarried indi-
vidual, the first $12,000 of resources may,
at the option of the State, be dis-
regarded;’’.
(b) CONFORMING SSI PERSONAL NEEDS ALLOW-
ANCE.—For provision increasing SSI personal needs al-
lowance, see section 4301.
(c) FEDERAL REIMBURSEMENT FOR REDUCTIONS IN
STATE
FUNDS
ATTRIBUTABLE
TO
INCREASED
DIS-
REGARD.—Section 1903(a) (42 U.S.C. 1396b(a)) is
amended—
(1) by striking ‘‘plus’’ at the end of paragraph
(6);
(2) by striking the period at the end of para-
graph (7) and inserting ‘‘; plus’’; and
(3) by adding at the end the following new
paragraph:
‘‘(8) an amount equal to 100 percent of the dif-
ference between the amount of expenditures made by
the State for nursing facility services and services in
an intermediate care facility for the mentally re-
tarded during the quarter and the amount of ex-
penditures that would have been made by the State
for such services during the quarter based on the
814
Title IV, Subtitle C
personal needs allowance in effect in the State as of
September 30, 1993.’’.
(d) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply with respect to months begin-
ning with January 1996.
SEC. 4213. INFORMING NURSING HOME RESIDENTS ABOUT
AVAILABILITY OF ASSISTANCE FOR HOME
AND COMMUNITY-BASED SERVICES.
(a) IN
GENERAL.—Section 1902(a) (42 U.S.C.
1396a(a)), as amended by section 4201(b), is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(62),
(2) by striking the period at the end of para-
graph (63) and inserting ‘‘; and’’, and
(3) by inserting after paragraph (63) the fol-
lowing new paragraph:
‘‘(64) provide, in the case of an individual who
is a resident (or who is applying to become a resi-
dent) of a nursing facility or intermediate care facil-
ity for the mentally retarded, at the time of applica-
tion for medical assistance and periodically there-
after, the individual (or a designated representative)
with information on the range of home and commu-
nity-based services for which assistance is available
in the State either under the plan under this title,
815
Title IV, Subtitle C
under the program under part 1 of subtitle B of title
II of the Health Security Act, or any other public
program.’’.
(b) EFFECTIVE DATE.—The amendments made by
this section shall apply to quarters beginning on or after
January 1, 1996.
PART 3—OTHER BENEFITS
SEC. 4221. TREATMENT OF ITEMS AND SERVICES NOT COV-
ERED UNDER THE COMPREHENSIVE BENEFIT
PACKAGE.
(a) CONTINUATION OF ELIGIBILITY FOR ASSISTANCE
FOR AFDC AND SSI RECIPIENTS.—With respect to an
individual who is described in section 1933(b) of the Social
Security Act (as added by subsection (b)(1)), nothing in
this Act shall be construed as—
(1) changing the eligibility of the individual for
medical assistance under title XIX of the Social Se-
curity Act for items and services not covered under
the comprehensive benefit package, or
(2) subject to the amendments made by this
subtitle, changing the amount, duration, or scope of
medical assistance required (or permitted) to be pro-
vided to the individual under such title.
(b) LIMITATION
ON SCOPE
OF ASSISTANCE
FOR
OTHER MEDICAID BENEFICIARIES.—
816
Title IV, Subtitle C
(1) IN GENERAL.—Title XIX, as amended by
sections 4201(a) and 4213, is amended by redesig-
nating section 1933 as section 1934 and by inserting
after section 1932 the following new section:
‘‘LIMITATION ON SCOPE OF ASSISTANCE FOR MOST NON-
CASH BENEFICIARIES
‘‘SEC 1933. (a) LIMITATION.—Notwithstanding any
other provision of this title, the medical assistance made
available under section 1902(a) to an individual not de-
scribed in subsection (b) shall be limited to medical assist-
ance for—
‘‘(1) long-term care services (as defined in sub-
section (c)); and
‘‘(2) medicare cost-sharing (as defined in sec-
tion 1905(p)(3)), in accordance with the require-
ments of section 1902(a)(10)(E).
‘‘(b) INDIVIDUALS EXEMPT FROM LIMITATION.—The
individuals described in this subsection are the following:
‘‘(1) AFDC recipients (as defined in section
1902(3) of the Health Security Act).
‘‘(2) SSI recipients (as defined in section
1902(33) of the Health Security Act).
‘‘(3) Individuals entitled to benefits under title
XVIII.
‘‘(4) Children under 18 years of age (or, at the
option of the State, under age 19, 20, or 21).
817
Title IV, Subtitle C
‘‘(c) LONG-TERM CARE SERVICES DEFINED.—In
subsection (a), the term ‘long-term care services’ means
the following items and services, but only to the extent
they are not included as an item or service under the com-
prehensive benefit package under the Health Security Act:
‘‘(1) Nursing facility services and intermediate
care facility services for the mentally retarded (in-
cluding items and services that may be included in
such services pursuant to regulations in effect as of
October 26, 1993).
‘‘(2) Personal care services.
‘‘(3) Home or community-based services pro-
vided under a waiver granted under subsection (c),
(d), or (e) of section 1915.
‘‘(4) Home and community care provided to
functionally disabled elderly individuals under sec-
tion 1929.
‘‘(5) Community supported living arrangements
services provided under section 1930.
‘‘(6) Case-management services (as described in
section 1915(g)(2)).
‘‘(7) Home health care services, clinic services,
and rehabilitation services that are furnished to an
individual who has a condition or disability that
818
Title IV, Subtitle C
qualifies the individual to receive any of the services
described in paragraphs (1) through (6).’’.
(2) 
CONFORMING
AMENDMENT.—Section
1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10)),
as amended by section 13603(c)(1) of OBRA–1993
and section 4211(b), is amended in the matter fol-
lowing subparagraph (G) (as inserted by section
4212(a))—
(A) by striking ‘‘and (XIV)’’ and inserting
‘‘(XIV)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (XV) the medical
assistance made available to an individual who
is not described in section 1933(b) shall be lim-
ited in accordance with section 1933’’.
(c) CONFORMING AMENDMENTS RELATING TO SEC-
ONDARY PAYER.—(1) Section 1902(a)(25)(A) (42 U.S.C.
1396a(a)(25)(A)), as amended by section 13622(a) of
OBRA–1993, is amended by inserting ‘‘health plans (as
defined in section 1400 of the Health Security Act),’’ after
‘‘of 1974),’’.
(2) Section 1903(o) (42 U.S.C. 1396b(o)), as so
amended, is amended by inserting ‘‘and a health plan (as
defined in section 1400 of the Health Security Act)’’ after
‘‘of 1974)’’.
819
Title IV, Subtitle C
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished in
a State on or after January 1 of the first year for which
the State is a participating State under the Health Secu-
rity Act.
SEC. 4222. ESTABLISHMENT OF PROGRAM FOR POVERTY-
LEVEL CHILDREN WITH SPECIAL NEEDS.
(a) ESTABLISHMENT OF PROGRAM.—Title XIX, as
amended by sections 4201, 4213, and 4221(b), is amended
by redesignating section 1934 as section 1935 and by in-
serting after section 1933 the following new section:
‘‘SERVICES FOR POVERTY-LEVEL CHILDREN WITH
SPECIAL NEEDS
‘‘SEC 1934. (a) ESTABLISHMENT OF PROGRAM.—
There is hereby established a program under which the
Secretary shall provide for payment on behalf of each
qualified child (as defined in subsection (b)) during a year
for all medically necessary or appropriate items and serv-
ices described in section 1905(a) (including items and
services described in section 1905(r) but excluding long-
term care services described in section 1933(c)) that are
not included in the comprehensive benefit package under
subtitle B of title I of the Health Security Act.
‘‘(b) QUALIFIED CHILD DEFINED.—
821
Title IV, Subtitle C
bus Budget Reconciliation Act of 1981, ap-
plicable to a family of the size involved)
(or, in the case of a State that established
an income level greater than 133 percent
for individuals under 1 year of age for pur-
poses of section 1902(l)(2)(A) as of Octo-
ber 1, 1993, an income level which is a
percentage of such level not greater than
185 percent),
‘‘(ii) the individual has attained 1
year of age but is under 6 years of age and
has adjusted family income at or below
133 percent of such income official poverty
line, or
‘‘(iii) the individual was born after
September 30, 1983, has attained 6 years
of age, and has adjusted family income at
or below 100 percent of such income offi-
cial poverty line.
‘‘(3) ENROLLMENT PROCEDURES.—
‘‘(A) IN GENERAL.—Not later than July 1,
1995, the Secretary shall establish procedures
for the enrollment of qualified children in the
program under this section under which—
822
Title IV, Subtitle C
‘‘(i) essential community providers
certified by the Secretary under subpart B
of part 2 of subtitle F of title I of the
Health Security Act serve as enrollment
sites for the program; and
‘‘(ii) any forms used for enrollment
purposes are designed to make the enroll-
ment as simple as practicable.
‘‘(B) 
INDIVIDUALS
UNDER
ALLIANCE
PLANS AUTOMATICALLY ENROLLED.—The Sec-
retary shall establish a process under which an
individual who is a qualified child under para-
graph (1) and is enrolled in a health plan (as
defined in section 1400(a) of the Health Secu-
rity Act) shall automatically be deemed to have
met any enrollment requirements established
under paragraph (1).
‘‘(c) 
ADDITIONAL
RESPONSIBILITIES
OF
SEC-
RETARY.—Not later than July 1, 1995, the Secretary shall
promulgate such regulations as are necessary to establish
and operate the program under this section, including reg-
ulations with respect to the following:
‘‘(1) The benefits to be provided and the cir-
cumstances under which such benefits shall be con-
sidered medically necessary.
823
Title IV, Subtitle C
‘‘(2) Procedures for the periodic redetermina-
tion of an individual’s eligibility for benefits.
‘‘(3) Qualification criteria for providers partici-
pating in the program.
‘‘(4) Payment amounts for services provided
under the program, the methodology used to deter-
mine such payment amounts, and the procedures for
making payments to providers.
‘‘(5) Standards to ensure the quality of services
and the coordination of services under the program
with services under the comprehensive benefit pack-
age, as well as services under parts B and H of the
Individuals With Disabilities Education Act, title V,
and any other program providing health care, reme-
dial, educational, and social services to qualified chil-
dren as the Secretary may identify.
‘‘(6) Hearing and appeals for individuals ad-
versely affected by any determination by the Sec-
retary under the program.
‘‘(7) Such other requirements as the Secretary
determines to be necessary for the proper and effi-
cient administration of the program.
‘‘(d) FEDERAL PAYMENT FOR PROGRAM.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
the Secretary shall pay 100 percent of the costs of
824
Title IV, Subtitle C
providing benefits under this program in a year, in-
cluding all administrative expenses.
‘‘(2) ANNUAL LIMIT ON EXPENDITURES.—The
total amount of Federal expenditures that may be
made under this section in a year may not exceed—
‘‘(A) for a year prior to 1998, an amount
equal to total expenditures for medical assist-
ance under State plans under this title during
fiscal year 1993 for services described in sub-
section (a) furnished to qualified children that
are attributable to States in which the program
is in operation during the year (adjusted to
take into account the operation of the program
under this section on a calendar year basis)—
‘‘(i) adjusted to take into account any
increases or decreases in the number of
qualified children under the most recent
decennial census, as adjusted by the most
recent current population survey for the
year in question, and
‘‘(ii) adjusted by the applicable per-
centage applied to the State non-cash, non-
DSH baseline amount for the year under
section 9003(a) of the Health Security Act;
825
Title IV, Subtitle C
‘‘(B) for 1998, the total expenditures for
medical assistance under State plans under this
title during 1993 for services described in sub-
section (a) furnished to qualified children (ad-
justed to take into account the operation of the
program under this section on a calendar year
basis)—
‘‘(i) adjusted to take into account any
increases or decreases in the number of
qualified children under the most recent
decennial census, as adjusted by the most
recent current population survey for the
year in question, and
‘‘(ii) adjusted by the update applied to
the State non-cash, non-DSH baseline
amount for the year under section 9003(b)
of the Health Security Act; and
‘‘(C) for each succeeding year, the limit es-
tablished under this paragraph for the previous
year (adjusted to take into account the oper-
ation of the program under this section on a
calendar year basis), adjusted by the update ap-
plied to the State non-cash baseline amount for
the year under section 9003(b) of the Health
Security Act.’’.
826
Title IV, Subtitle C
(b) REPEAL OF ALTERNATIVE ELIGIBILITY STAND-
ARDS FOR CHILDREN IN PARTICIPATING STATES.—Sec-
tion 1902(r)(2) (42 U.S.C. 1396a(r)(2)) is amended by
adding at the end the following new subparagraph:
‘‘(C) Subparagraph (A) shall not apply with respect
to the determination of income and resources for children
under age 18 under the State plan of a State (other than
under the State plan of a State that utilized an alternative
methodology pursuant to such subparagraph as of October
1, 1993)—
‘‘(i) in the case of a State that is a partici-
pating State under the Health Security Act for a
year prior to 1998, for quarters beginning on or
after January 1 of the first year for which the State
is such a participating State; and
‘‘(ii) in the case of any State not described in
clause (i), for quarters beginning on or after Janu-
ary 1, 1998.’’.
PART 4—DISCONTINUATION OF CERTAIN
PAYMENT POLICIES
SEC. 4231. DISCONTINUATION OF MEDICAID DSH PAY-
MENTS.
(a) ELIMINATION OF SPECIFIC OBLIGATION.—Sec-
tion 1923(a) (42 U.S.C. 1396r–4(a)) is amended by add-
ing at the end the following new paragraph:
827
Title IV, Subtitle C
‘‘(5) Notwithstanding any other provision of
this title, the requirement of this subsection shall
not apply—
‘‘(A) with respect to a State for any por-
tion of a fiscal year during which the State is
a participating State under the Health Security
Act; or
‘‘(B) with respect to any State for any
months beginning on or after January 1,
1998.’’.
(b) ELIMINATION OF STATE PLAN REQUIREMENT.—
Section 1902(a)(13)(A) (42 U.S.C. 1396a(a)(13)(A)) is
amended by inserting after ‘‘special needs’’ the following:
‘‘(but only with respect to any quarters during which the
State is not a participating State under the Health Secu-
rity Act or with respect to any quarters ending on or be-
fore December 31, 1997)’’.
(c) ELIMINATION OF STATE DSH ALLOTMENTS AND
FEDERAL FINANCIAL PARTICIPATION.—Section 1923(f)
(42 U.S.C. 1396r–4(f)) is amended—
(1) in paragraph (2), by inserting ‘‘and para-
graph (5)’’ after ‘‘subparagraph (B)’’, and
(2) by adding at the end the following new
paragraph:
828
Title IV, Subtitle C
‘‘(5) ELIMINATION OF ALLOTMENTS FOR PAR-
TICIPATING
STATES
AND
SUNSET
FOR
ALL
STATES.—
‘‘(A) IN GENERAL.—Notwithstanding any
other provision of this section, the State DSH
allotment shall be zero with respect to—
‘‘(i) any participating State under the
Health Security Act; and
‘‘(ii) any State for any portion of a
fiscal year that occurs on or after January
1, 1998.
‘‘(B) NO
REDISTRIBUTION
OF
REDUC-
TIONS.—In the computation of State supple-
mental amounts under paragraph (3), the State
DSH allotments shall be determined under sub-
paragraph (A)(ii) of such paragraph as if this
paragraph did not apply.’’.
SEC. 4232. DISCONTINUATION OF REIMBURSEMENT STAND-
ARDS FOR INPATIENT HOSPITAL SERVICES.
Section 
1902(a)(13)(A) 
(42 
U.S.C.
1396a(a)(13)(A)), as amended by section 4231(b), is
amended by inserting ‘‘(in the case of services other than
hospital services in a State that is a participating State
under the Health Security Act)’’ before ‘‘are reasonable
and adequate’’.
829
Title IV, Subtitle C
PART 5—COORDINATION WITH ADMINISTRATIVE
SIMPLIFICATION 
AND 
QUALITY 
MANAGE-
MENT INITIATIVES
SEC. 4241. REQUIREMENTS FOR CHANGES IN BILLING PRO-
CEDURES.
(a) LIMITATION
ON
FREQUENCY
OF
SYSTEM
CHANGES; ADVANCE NOTIFICATION
TO PROVIDERS.—
Section 1902(a) (42 U.S.C. 1396a(a)), as amended by sec-
tions 4201(b) and 4214(a), is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(63),
(2) by striking the period at the end of para-
graph (64) and inserting ‘‘; and’’, and
(3) by inserting after paragraph (64) the fol-
lowing new paragraph:
‘‘(65) provide that the State—
‘‘(A) will not implement any change in the
system used for the billing and processing of
claims for payment for items and services fur-
nished under the State plan within 6 months of
implementing any previous change in such sys-
tem; and
‘‘(B) shall notify individuals and entities
providing medical assistance under the State
plan of any major change in the procedures for
billing for services furnished under the plan at
830
Title IV, Subtitle C
least 120 days before such change is to take ef-
fect.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to a State as of January 1 of
the first year for which the State is a participating State.
PART 6—MEDICAID COMMISSION
SEC. 4251. MEDICAID COMMISSION.
(a) ESTABLISHMENT.—There is established a com-
mission to be known as the ‘‘Medicaid Commission’’ (in
this section referred to as the ‘‘Commission’’).
(b) MEMBERSHIP.—(1) The Commission shall be
composed of 15 members appointed by the Secretary for
the life of the Commission.
(2) Members shall include representatives of the Fed-
eral Government and State Governments.
(3) The Administrator of the Health Care Financing
Administration shall be an ex officio member of the Com-
mission.
(4) Individuals, while serving as members of the
Commission, shall not be entitled to compensation, other
than travel expenses, including per diem in lieu of subsist-
ence, in accordance with sections 5702 and 5703 of title
5, United States Code.
(c) STUDY.—The Commission shall study options
with respect to each of the following in relation to the
831
Title IV, Subtitle C
medicaid program under title XIX of the Social Security
Act:
(1) USE OF BLOCK GRANT.—Whether, and (if
so) how, to convert payments for services not cov-
ered in the comprehensive benefit package (for all
recipients, including AFDC and SSI recipients de-
fined in section 1902) into new financing mecha-
nisms that give the States greater flexibility in tar-
geting and delivering needed services.
(2) INTEGRATION OF ACUTE AND LONG-TERM
CARE SERVICES FOR HEALTH PLANS.—Whether, and
(if so) how, to integrate long-term care services and
the home and community-based services program
under part 1 of subtitle B of title II with the serv-
ices covered under the comprehensive benefit pack-
age offered by health plans.
(3) CONSOLIDATING INSTITUTIONAL AND HOME
AND COMMUNITY-BASED LONG-TERM CARE.—Wheth-
er, and (if so) how, to offer States an option to com-
bine together expenditures under the home and com-
munity-based services program (under part 1 of sub-
title B of title II) with continuing home and commu-
nity-based services and institutional care under the
medicaid program into a global budget for long-term
832
Title IV, Subtitle C
care services, and how such a combined program
could be implemented.
(d) REPORT AND RECOMMENDATIONS.—The Com-
mission shall submit to the Secretary and the National
Health Board, not later than 1 year after the date of the
enactment of this Act, a report on its study under sub-
section (c). The Commission shall include in such report
such recommendations for changes in the medicaid pro-
gram, and the programs under this Act, as it deems ap-
propriate.
(e) OPERATIONS.—(1) The Commission shall appoint
a chair from among its members.
(2) Upon request of the Chair of the Commission,
the head of any Federal department or agency may detail,
on a reimbursable basis, any of the personnel of that de-
partment or agency to the Commission to assist it in car-
rying out its duties under this section.
(3) The Commission may secure directly from any de-
partment or agency of the United States information nec-
essary to enable it to carry out this section. Upon request
of the Chair of the Commission, the head of that depart-
ment or agency shall furnish that information to the Com-
mission.
(4) Upon the request of the Commission, the Admin-
istrator of General Services shall provide to the Commis-
833
Title V
sion, on a reimbursable basis, the administrative support
services necessary for the Commission to carry out its re-
sponsibilities under this section.
(f) TERMINATION.—The Commission shall terminate
90 days after the date of submission of its report under
subsection (d).
(g) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated such sums as may be
necessary to carry out this section.
Subtitle D—Increase in SSI
Personal Needs Allowance
SEC. 4301. INCREASE IN SSI PERSONAL NEEDS ALLOW-
ANCE.
(a) IN GENERAL.—Section 1611(e)(1)(B) (42 U.S.C.
1382(e)(1)(B)) is amended—
(1) in clauses (i) and (ii)(I), by striking ‘‘$360’’
and inserting ‘‘$600’’; and
(2) in clause (iii), by striking ‘‘$720’’ and in-
serting ‘‘$1,200’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply with respect to months begin-
ning with January 1996.
TITLE V—QUALITY AND
CONSUMER PROTECTION
TABLE OF CONTENTS OF TITLE