I 
109TH CONGRESS 
2D SESSION 
H. R. 5686 
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 26, 2006 
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 screen-
ing 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 ‘‘Medicaid Prostate 
Cancer Coverage Act of 2006’’. 
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SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN 
PROSTATE CANCER PATIENTS. 
(a) 
COVERAGE
AS
OPTIONAL
CATEGORICALLY 
NEEDY GROUP.— 
(1) IN
GENERAL.—Section 1902(a)(10)(A)(ii) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(ii)) is amended— 
(A) in subclause (XVIII), by striking ‘‘or’’ 
at the end; 
(B) in subclause (XIX), by adding ‘‘or’’ at 
the end; and 
(C) by adding at the end the following: 
‘‘(XX) who are described in sub-
section (dd) (relating to certain pros-
tate cancer patients);’’. 
(2) GROUP DESCRIBED.—Section 1902 of such 
Act (42 U.S.C. 1396a) is amended by adding at the 
end the following: 
‘‘(dd) Individuals described in this paragraph are in-
dividuals who— 
‘‘(1) 
are 
not 
described 
in 
subsection 
(a)(10)(A)(i); 
‘‘(2) have not attained age 65; 
‘‘(3) have been screened for prostate cancer 
under section 317D of the Public Health Service Act 
(42 U.S.C. 247b–5), or any other prostate cancer 
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screening program supported with Federal funds, 
and need treatment for prostate cancer; 
‘‘(4) are in families whose income does not ex-
ceed 250 percent of the income official poverty line 
(as defined by the Office of Management and Budg-
et, and revised annually in accordance with section 
673(2) of the Omnibus Budget Reconciliation Act of 
1981) applicable to a family of the size involved; and 
‘‘(5) 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)).’’. 
(3) 
LIMITATION
ON
BENEFITS.—Section 
1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10)) 
is amended in the matter following subparagraph 
(G)— 
(A) by striking ‘‘and (XIV)’’ and inserting 
‘‘(XIV)’’; and 
(B) by inserting ‘‘, and (XV) the medical 
assistance made available to an individual de-
scribed in subsection (aa) who is eligible for 
medical assistance only because of subpara-
graph (A)(10)(ii)(XX) shall be limited to med-
ical assistance provided during the period in 
which such an individual requires treatment for 
prostate cancer’’ before the semicolon. 
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(4) 
CONFORMING
AMENDMENTS.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended in the matter preceding para-
graph (1)— 
(A) in clause (xii), by striking ‘‘or’’ at the 
end; 
(B) in clause (xiii), by adding ‘‘or’’ at the 
end; and 
(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(xiv) 
individuals 
described 
in 
section 
1902(dd),’’. 
(b) 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 1920B the following: 
‘‘PRESUMPTIVE ELIGIBILITY FOR CERTAIN PROSTATE 
CANCER PATIENTS 
‘‘SEC. 1920C. (a) STATE OPTION.—A State plan ap-
proved under section 1902 may provide for making med-
ical assistance available to an individual described in sec-
tion 1902(dd) (relating to certain prostate cancer pa-
tients) during a presumptive eligibility period. 
‘‘(b) DEFINITIONS.—For purposes of this section: 
‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The 
term ‘presumptive eligibility period’ means, with re-
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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(dd); 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 
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‘‘(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 pre-
venting a State from limiting the classes of en-
tities that may become qualified entities, con-
sistent with any limitations imposed under sub-
paragraph (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 
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(a) is presumptively eligible for medical assistance 
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 enti-
ty to be presumptively eligible for medical assistance 
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 dur-
ing which the determination is made. 
‘‘(d) PAYMENT.—Notwithstanding any other provi-
sion of this title, medical assistance that— 
‘‘(1) is furnished to an individual described in 
subsection (a)— 
‘‘(A) during a presumptive eligibility pe-
riod; 
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‘‘(B) by a entity that is eligible for pay-
ments under the State plan; and 
‘‘(2) is included in the care and services covered 
by the State plan; 
shall be treated as medical assistance provided by such 
plan for purposes of section 1903(a)(5)(B).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1902(a)(47) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(47)) is amend-
ed— 
(i) by striking ‘‘and provide’’ and in-
serting ‘‘, provide’’; and 
(ii) by inserting before the semicolon 
at the end the following: ‘‘, and provide for 
making medical assistance available to in-
dividuals described in subsection (a) of sec-
tion 1920C during a presumptive eligibility 
period in accordance 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 pro-
vided to an individual described in sub-
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section (a) of section 1920C during a pre-
sumptive eligibility period under such sec-
tion’’. 
(c) 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 prostate cancer- 
related treatment services; plus’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section apply to medical assistance furnished on or 
after the date of the enactment of this Act, without regard 
to whether final regulations to carry out such amendments 
have been promulgated by such date. 
Æ 
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