I
104TH CONGRESS
1ST SESSION
H. R. 1503
To amend title XIX of the Social Security Act to require State medicaid
plans to cover services of certain clinics operated by children’s hospitals
and to reimburse such clinics for such services in an amount equal
to 100 percent of the costs which are reasonable and related to the
cost of furnishing such services.
IN THE HOUSE OF REPRESENTATIVES
APRIL 7, 1995
Mrs. LINCOLN introduced the following bill; which was referred to the
Committee on Commerce
A BILL
To amend title XIX of the Social Security Act to require
State medicaid plans to cover services of certain clinics
operated by children’s hospitals and to reimburse such
clinics for such services in an amount equal to 100
percent of the costs which are reasonable and related
to the cost of furnishing such services.
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 ‘‘Access to Children’s
Health Care Act of 1995’’.
SEC. 2. MANDATORY COVERAGE OF SERVICES OF CLINICS
OPERATED 
BY 
CHILDREN’S 
HOSPITALS
UNDER STATE MEDICAID PLANS.
(a) IN GENERAL.—Section 1905(a)(2) of the Social
Security Act (42 U.S.C. 1396d(a)(2)) is amended—
(1) by striking ‘‘and (C)’’ and inserting ‘‘(C)’’;
and
(2) by striking the semicolon at the end and in-
serting the following: ‘‘, and (D) qualified children’s
hospital clinic services (as defined in subsection
(l)(3));’’.
(b) QUALIFIED
CHILDREN’S
HOSPITAL
CLINIC
SERVICES DESCRIBED.—Section 1905(l) of such Act (42
U.S.C. 1396d(l)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(3)(A) The term ‘qualified children’s hospital clinic
services’ means services of the type described in subpara-
graphs (A) through (C) of section 1861(aa)(1) and any
other ambulatory services for which payment may be made
under the State plan, when furnished to a patient of a
qualified children’s hospital clinic (as defined in subpara-
graph (B)).
‘‘(B) The term ‘qualified children’s hospital clinic’
means an entity which—
‘‘(i) is operated by a hospital whose inpatients
are predominantly individuals under 18 years of age;
‘‘(ii) meets the requirements to receive a grant
under section 330 of the Public Health Service Act,
or which would meet such requirements but for the
entity’s failure to meet the requirements of section
330(e)(3)(G) of such Act;
‘‘(iii) has a consumer advisory board composed
of individuals, a majority of whom are immediate
family members of patients served by the entity, who
advise the hospital operating the entity on the enti-
ty’s annual budget, the selection of the entity’s gen-
eral director, and other general policies for the en-
tity; and
‘‘(iv) has written inpatient and outpatient refer-
ral arrangements in effect with each Federally-quali-
fied health center under paragraph (2)(B) that is lo-
cated or provides services within the service area of
the hospital operating the entity.’’.
SEC. 3. REIMBURSEMENT OF QUALIFIED CHILDREN’S HOS-
PITAL CLINIC SERVICES AT 100 PERCENT OF
REASONABLE COST.
Section 1902(a)(13)(E) of the Social Security Act
(42 U.S.C. 1396a(a)(13)(E)) is amended by striking ‘‘(B)
or (C)’’ and inserting ‘‘(B), (C), or (D)’’.
SEC. 4. EFFECTIVE DATE.
(a) IN GENERAL.—The amendments made by this
Act shall apply to calendar quarters beginning on or after
January 1, 1996, without regard to whether or not final
regulations to carry out such amendments have been pro-
mulgated by such date.
(b) SPECIAL RULE FOR STATES REQUIRING LEGIS-
LATION TO MODIFY MEDICAID PLANS.—In the case of
a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and
Human Services determines requires State legislation
(other than legislation appropriating funds) in order for
the plan to meet the additional requirements imposed by
the amendments made by this Act, the State plan shall
not be regarded as failing to comply with the requirements
of such title solely on the basis of its failure to meet these
additional requirements before the first day of the first
calendar quarter beginning after the close of the first reg-
ular session of the State legislature that begins after the
date of the enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-
year legislative session, each year of such session shall be
deemed to be a separate regular session of the State legis-
lature.
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