190
poses of part C of title XVIII of the Social Security
Act, as having discontinued enrollment in such a
plan as of the date of enactment of this Act.
SEC. 604. COVERAGE OF CERTAIN VASCULAR ACCESS SERV-
ICES FOR ESRD BENEFICIARIES PROVIDED
BY AMBULATORY SURGICAL CENTERS.
(a) IN GENERAL.—The matter following subpara-
graph (B) of section 1833(i)(1) (42 U.S.C. 1395l(i)(1))
is amended by adding at the end the following new sen-
tence: ‘‘Such lists shall include the procedures identified
as of July 30, 1999, by vascular access codes 34101,
34111, 34490, 35190, 35458, 35460, 35475, 35476,
35903, 36005, 36010, 36011, 36120, 36140, 36145,
36215–36218, 
36831–36834, 
37201, 
37204–37208,
37250, 37251, and 49423.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to vascular access services fur-
nished on or after January 1, 2000.
SEC. 605. COLLECTION AND ANALYSIS OF INFORMATION
ON 
THE 
SATISFACTION 
OF 
ESRD 
BENE-
FICIARIES WITH THE QUALITY OF AND AC-
CESS TO HEALTH CARE UNDER THE MEDI-
CARE PROGRAM.
(a) COLLECTION OF INFORMATION.—The Secretary
shall collect information on the satisfaction of each ESRD
191
medicare beneficiary with the quality of health care under
the original fee-for-service medicare program and the
Medicare+Choice program, and the access of each bene-
ficiary to that care.
(b) ANALYSIS OF COLLECTED INFORMATION.—
(1) IN GENERAL.—The Secretary shall conduct
an analysis of the information collected under sub-
section (a) to determine—
(A) the kinds of health care that each non-
dialysis health care provider provides to each
ESRD medicare beneficiary for the treatment
of end-stage renal disease and each comor-
bidity;
(B) the effect of the availability of supple-
mental insurance on the use by beneficiary of
health care;
(C) the perceptions of each beneficiary re-
garding the access of that beneficiary to health
care; and
(D) the quality of health care provided to
each ESRD medicare beneficiary enrolled under
the Medicare+Choice program compared to
each beneficiary enrolled under the original fee-
for-service medicare program.
192
(2) CONSIDERATIONS.—In conducting the anal-
ysis under paragraph (1), the Secretary shall
consider—
(A) the feasibility of routinely collecting in-
formation on the satisfaction of each ESRD
medicare beneficiary with dialysis and non-di-
alysis health care;
(B) whether to collect information using
disease specific questions or generic questions
(similar to those used in conducting the Medi-
care Current Beneficiary Survey);
(C) how well collected information detects
access problems within each specific group of
ESRD medicare beneficiaries, including bene-
ficiaries without supplemental insurance and
beneficiaries that reside in a rural area; and
(D) each obstacle that a health care pro-
vider may face in offering each type of dialysis
service.
(c) AVAILABILITY
OF INFORMATION
AND ANAL-
YSIS.—Not later than January 1 of each year (beginning
in 2002) the Secretary shall make the information col-
lected under subsection (a) and the analysis conducted
under subsection (b) available to the public.
(d) DEFINITIONS.—In this section:
193
(1) ESRD MEDICARE BENEFICIARY.—The term
‘‘ESRD medicare beneficiary’’ means an individual
eligible for benefits under the medicare program that
has end-stage renal disease (including an individual
enrolled in a Medicare+Choice plan offered by a
Medicare+Choice 
organization 
under 
the
Medicare+Choice program).
(2) MEDICARE+CHOICE PROGRAM.—The term
‘‘Medicare+Choice program’’ means the program es-
tablished under part C of title XVIII of the Social
Security Act (42 U.S.C. 1395w–21 et seq.).
(3) ORIGINAL
FEE-FOR-SERVICE
MEDICARE
PROGRAM.—The term ‘‘original fee-for-service medi-
care program’’ means the health benefits program
under parts A and B title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.).
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services, acting
through the Administrator of the Health Care Fi-
nancing Administration.
194
TITLE VII—ACCESS TO CARE IM-
PROVEMENTS 
THROUGH
MEDICAID AND SCHIP
SEC. 701. NEW PROSPECTIVE PAYMENT SYSTEM FOR FED-
ERALLY-QUALIFIED HEALTH CENTERS AND
RURAL HEALTH CLINICS.
(a) IN
GENERAL.—Section 1902(a) (42 U.S.C.
1396a(a)) is amended—
(1) in paragraph (13)—
(A) in subparagraph (A), by adding ‘‘and’’
at the end;
(B) in subparagraph (B), by striking
‘‘and’’ at the end; and
(C) by striking subparagraph (C); and
(2) by inserting after paragraph (14) the fol-
lowing new paragraph:
‘‘(15) for payment for services described in sub-
paragraph (B) or (C) of section 1905(a)(2) under
the plan in accordance with subsection (aa);’’.
(b) NEW PROSPECTIVE PAYMENT SYSTEM.—Section
1902 (42 U.S.C. 1396a) is amended by adding at the end
the following:
‘‘(aa) PAYMENT FOR SERVICES PROVIDED BY FED-
ERALLY-QUALIFIED
HEALTH
CENTERS
AND
RURAL
HEALTH CLINICS.—
195
‘‘(1) IN GENERAL.—Beginning with fiscal year
2001 and each succeeding fiscal year, the State plan
shall provide for payment for services described in
section 1905(a)(2)(C) furnished by a Federally-
qualified health center and services described in sec-
tion 1905(a)(2)(B) furnished by a rural health clinic
in accordance with the provisions of this subsection.
‘‘(2) FISCAL YEAR 2001.—Subject to paragraph
(4), for services furnished during fiscal year 2001,
the State plan shall provide for payment for such
services in an amount (calculated on a per visit
basis) that is equal to 100 percent of the costs of
the center or clinic of furnishing such services dur-
ing fiscal year 2000 which are reasonable and re-
lated to the cost of furnishing such services, or
based on such other tests of reasonableness as the
Secretary prescribes in regulations under section
1833(a)(3), or, in the case of services to which such
regulations do not apply, the same methodology used
under section 1833(a)(3), adjusted to take into ac-
count any increase in the scope of such services fur-
nished by the center or clinic during fiscal year
2001.
‘‘(3) FISCAL YEAR 2002 AND SUCCEEDING FIS-
CAL YEARS.—Subject to paragraph (4), for services
196
furnished during fiscal year 2002 or a succeeding
fiscal year, the State plan shall provide for payment
for such services in an amount (calculated on a per
visit basis) that is equal to the amount calculated for
such services under this subsection for the preceding
fiscal year—
‘‘(A) increased by the percentage increase
in the MEI (as defined in section 1842(i)(3))
applicable to primary care services (as defined
in section 1842(i)(4)) for that fiscal year; and
‘‘(B) adjusted to take into account any in-
crease in the scope of such services furnished by
the center or clinic during that fiscal year.
‘‘(4) ESTABLISHMENT OF INITIAL YEAR PAY-
MENT AMOUNT FOR NEW CENTERS OR CLINICS.—In
any case in which an entity first qualifies as a Fed-
erally-qualified health center or rural health clinic
after fiscal year 2000, the State plan shall provide
for payment for services described in section
1905(a)(2)(C) furnished by the center or services
described in section 1905(a)(2)(B) furnished by the
clinic in the first fiscal year in which the center or
clinic so qualifies in an amount (calculated on a per
visit basis) that is equal to 100 percent of the costs
of furnishing such services during such fiscal year in
197
accordance with the regulations and methodology re-
ferred to in paragraph (2). For each fiscal year fol-
lowing the fiscal year in which the entity first quali-
fies as a Federally-qualified health center or rural
health clinic, the State plan shall provide for the
payment amount to be calculated in accordance with
paragraph (3).
‘‘(5) ADMINISTRATION IN THE CASE OF MAN-
AGED CARE.—In the case of services furnished by a
Federally-qualified health center or rural health clin-
ic pursuant to a contract between the center or clinic
and a managed care entity (as defined in section
1932(a)(1)(B)), the State plan shall provide for pay-
ment to the center or clinic (at least quarterly) by
the State of a supplemental payment equal to the
amount (if any) by which the amount determined
under paragraphs (2), (3), and (4) of this subsection
exceeds the amount of the payments provided under
the contract.
‘‘(6) ALTERNATIVE
PAYMENT
METHODOLO-
GIES.—Notwithstanding any other provision of this
section, the State plan may provide for payment in
any fiscal year to a Federally-qualified health center
for services described in section 1905(a)(2)(C) or to
a rural health clinic for services described in section
198
1905(a)(2)(B) in an amount which is determined
under an alternative payment methodology that—
‘‘(A) is agreed to by the State and the cen-
ter or clinic; and
‘‘(B) results in payment to the center or
clinic of an amount which is at least equal to
the amount otherwise required to be paid to the
center or clinic under this section.’’.
(c) CONFORMING AMENDMENTS.—
(1) Section 4712 of BBA (111 Stat. 508) is
amended by striking subsection (c).
(2) Section 1915(b) (42 U.S.C. 1396n(b)) is
amended by striking ‘‘1902(a)(13)(E)’’ and insert-
ing ‘‘1902(a)(15), 1902(aa),’’.
(d) EFFECTIVE DATE.—The amendments made by
this section take effect on October 1, 2000, and apply to
services furnished on or after such date.
SEC. 702. TRANSITIONAL MEDICAL ASSISTANCE.
(a) MAKING PROVISION PERMANENT.—
(1) IN
GENERAL.—Subsection (f) of section
1925 (42 U.S.C. 1396r–6) is repealed.
(2) 
CONFORMING
AMENDMENT.—Section
1902(e)(1) (42 U.S.C. 1396a(e)(1)) is repealed.
199
(b) STATE OPTION OF INITIAL 12-MONTH ELIGI-
BILITY.—Section 
1925 
(42 
U.S.C. 
1396r–6) 
is
amended—
(1) in subsection (a), by adding at the end the
following new paragraph:
‘‘(5) OPTION OF 12-MONTH INITIAL ELIGIBILITY
PERIOD.—A State may elect to treat any reference
in this subsection to a 6-month period (or 6 months)
as a reference to a 12-month period (or 12 months).
In the case of such an election, subsection (b) shall
not apply.’’; and
(2) in subsection (b)(1), by inserting ‘‘and sub-
section (a)(5)’’ after ‘‘paragraph (3)’’.
(c) SIMPLIFICATION OPTIONS.—
(1) REMOVAL OF ADMINISTRATIVE REPORTING
REQUIREMENTS FOR ADDITIONAL 6-MONTH EXTEN-
SION.—Section 1925(b) (42 U.S.C. 1396r–6(b)) is
amended—
(A) in paragraph (2)—
(i) in the heading, by striking ‘‘AND
REPORTING’’;
(ii) by striking subparagraph (B);
(iii) in subparagraph (A)(i)—
200
(I) by striking ‘‘(I)’’ and all that
follows through ‘‘(II)’’ and inserting
‘‘(i)’’;
(II) by striking ‘‘, and (III)’’ and
inserting ‘‘and (ii)’’; and
(III) by redesignating such sub-
paragraph as subparagraph (A) (with
appropriate indentation); and
(iv) in subparagraph (A)(ii)—
(I) by striking ‘‘notify the family
of the reporting requirement under
subparagraph (B)(ii) and a statement
of’’ and inserting ‘‘provide the family
with notification of’’; and
(II) by redesignating such sub-
paragraph as subparagraph (B) (with
appropriate indentation);
(B) in paragraph (3)(A)—
(i) in clause (iii)—
(I) in the heading, by striking
‘‘REPORTING AND TEST’’;
(II) by striking subclause (I);
and
201
(III) by redesignating subclauses
(II) and (III) as subclauses (I) and
(II), respectively; and
(ii) by striking the last 3 sentences;
and
(C) in paragraph (3)(B), by striking ‘‘sub-
paragraph (A)(iii)(II)’’ and inserting ‘‘subpara-
graph (A)(iii)(I)’’.
(2) EXEMPTION FOR STATES COVERING NEEDY
FAMILIES UP TO 185 PERCENT OF POVERTY.—Sec-
tion 1925 (42 U.S.C. 1396r–6), as amended by sub-
section (a), is amended—
(A) in each of subsections (a)(1) and
(b)(1), by inserting ‘‘but subject to subsection
(f),’’ after ‘‘Notwithstanding any other provi-
sion of this title,’’; and
(B) by adding at the end the following new
subsection:
‘‘(f) EXEMPTION
FOR STATE COVERING NEEDY
FAMILIES UP TO 185 PERCENT OF POVERTY.—At State
option, the provisions of this section shall not apply to a
State that uses the authority under section 1931(b)(2)(C)
to make medical assistance available under the State plan
under this title, at a minimum, to all individuals described
in section 1931(b)(1) in families with gross incomes (de-
202
termined without regard to work-related child care ex-
penses of such individuals) at or below 185 percent of the
income official poverty line (as defined by the Office of
Management and Budget, and revised annually in accord-
ance with section 673(2) of the Omnibus Budget Rec-
onciliation Act of 1981) applicable to a family of the size
involved.’’.
(3) STATE OPTION TO ELECT SHORTER PERIOD
FOR REQUIREMENT FOR RECEIPT OF MEDICAL AS-
SISTANCE
AS
A
CONDITION
OF
ELIGIBILITY
FOR
TRANSITIONAL
MEDICAL
ASSISTANCE.—Section
1925(a)(1) (42 U.S.C. 1396r–6(a)(1)) is amended
by inserting ‘‘(or such shorter period as the State
may elect)’’ after ‘‘3’’.
(d) APPLICATION OF NOTICE OF ELIGIBILITY TO
ALL FAMILIES LEAVING WELFARE.—Section 1925(a) (42
U.S.C. 1396r–6(a)), as amended by subsection (b)(1), is
amended by adding at the end the following new para-
graph:
‘‘(6) NOTICE OF ELIGIBILITY FOR MEDICAL AS-
SISTANCE TO ALL FAMILIES LEAVING TANF.—Each
State shall notify each family which was receiving
assistance under the State program funded under
part A of title IV and which is no longer eligible for
such assistance, of the potential eligibility of the
203
family and any individual members of such family
for medical assistance under this title or child health
assistance under title XXI. Such notice shall include
a statement that the family does not have to be re-
ceiving assistance under the State program funded
under part A of title IV in order to be eligible for
such medical assistance or child health assistance.’’.
(e) ENROLLMENT DATA.—Section 1925 (42 U.S.C.
1396r–6), as amended by subsection (c)(2)(B), is amend-
ed by adding at the end the following new subsection:
‘‘(g) ENROLLMENT DATA.—The Secretary annually
shall obtain from each State with a State plan approved
under this title enrollment data regarding—
‘‘(1) the number of adults and children who—
‘‘(A) receive medical assistance under this
title based on eligibility under section 1931;
‘‘(B) at the time they were first deter-
mined to be eligible for such medical assistance,
also received cash assistance under the State
program funded under part A of title IV; and
‘‘(C) subsequently ceased to receive assist-
ance under such State program due to in-
creased earnings or increased child support in-
come;
204
‘‘(2) the percentage of the adults and children
described in paragraph (1) who receive transitional
medical assistance under this section or otherwise
remain enrolled in the program under this title; and
‘‘(3) the percentage of such adults and children
that receive such transitional medical assistance for
more than 6 months or that remain enrolled in the
program under this title for more than 6 months
after such adults or children ceased to receive assist-
ance under the State program funded under part A
of title IV.’’.
(f) EFFECTIVE DATE.—The amendments made by
this section take effect on October 1, 2000.
SEC. 703. APPLICATION OF SIMPLIFIED SCHIP PROCE-
DURES UNDER THE MEDICAID PROGRAM.
(a) COORDINATION WITH MEDICAID.—
(1) IN GENERAL.—Section 1902(l) (42 U.S.C.
1396a(l)) is amended—
(A) in paragraph (3), by inserting ‘‘subject
to paragraph (5)’’, after ‘‘Notwithstanding sub-
section (a)(17),’’; and
(B) by adding at the end the following new
paragraph:
‘‘(5) With respect to determining the eligibility of in-
dividuals under 19 years of age for medical assistance
205
under subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI),
(a)(10)(A)(i)(VII), 
(a)(10)(A)(ii)(IX), 
or
(a)(10)(A)(ii)(XIV), notwithstanding any other provision
of this title, if the State has established a State child
health plan under title XXI, or expanded coverage beyond
the income eligibility standards required for such individ-
uals under this title under a waiver granted under section
1115—
‘‘(A) the State may not apply a resource stand-
ard if the State does not apply such a standard
under such child health plan or section 1115 waiver
with respect to such individuals;
‘‘(B) the State shall use the same simplified eli-
gibility form (including, if applicable, permitting ap-
plication other than in person) as the State uses
under such State child health plan or section 1115
waiver with respect to such individuals;
‘‘(C) the State shall provide for initial eligibility
determinations and redeterminations of eligibility
using the same verification policies, forms, and fre-
quency as the State uses for such purposes under
such State child health plan or section 1115 waiver
with respect to such individuals; and
‘‘(D) the State shall not require a face-to-face
interview for purposes of initial eligibility determina-
206
tions and redeterminations unless the State required
such an interview for such purposes under such child
health plan or section 1115 waiver with respect to
such individuals.’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) take effect on October 1, 2000,
and apply to eligibility determinations and redeter-
minations made on or after such date.
(b) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR
TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN
LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—
(1) LOSS OF MEDICAID ELIGIBILITY.—Section
1902(a) of the Social Security Act (42 U.S.C.
1396a(a)) is amended—
(A) by striking the period at the end of
paragraph (65) and inserting ‘‘; and’’, and
(B) by inserting after paragraph (65) the
following new paragraph:
‘‘(66) provide, by not later than the first day of
the first month that begins more than 1 year after
the date of the enactment of this paragraph and in
the case of a State with a State child health plan
under title XXI, that before medical assistance to a
child (or a parent of a child) is discontinued under
this title, a determination of whether the child (or
207
parent) is eligible for benefits under title XXI shall
be made and, if determined to be so eligible, the
child (or parent) shall be automatically enrolled in
the program under such title without the need for a
new application and without being asked to provide
any information that is already available to the
State.’’.
(2) LOSS OF TITLE XXI ELIGIBILITY.—Section
2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by
redesignating subparagraphs (D) and (E) as sub-
paragraphs (E) and (F), respectively, and by insert-
ing after subparagraph (C) the following new sub-
paragraph:
‘‘(D) that before health assistance to a
child (or a parent of a child) is discontinued
under this title, a determination of whether the
child (or parent) is eligible for benefits under
title XIX is made and, if determined to be so
eligible, the child (or parent) is automatically
enrolled in the program under such title with-
out the need for a new application and without
being asked to provide any information that is
already available to the State;’’.
(3) EFFECTIVE DATE.—The amendments made
by paragraphs (1) and (2) apply to individuals who
208
lose eligibility under the medicaid program under
title XIX, or under a State child health insurance
plan under title XXI, respectively, of the Social Se-
curity Act (42 U.S.C. 1396 et seq.; 1397aa et seq.)
on or after the date that is 60 days after the date
of the enactment of this Act.
SEC. 704. PRESUMPTIVE ELIGIBILITY.
(a) ADDITIONAL ENTITIES QUALIFIED TO DETER-
MINE
PRESUMPTIVE
ELIGIBILITY
FOR
LOW-INCOME
CHILDREN.—
(1) MEDICAID.—Section 1920A(b)(3)(A)(i) (42
U.S.C. 1396r–1a(b)(3)(A)(i)) is amended—
(A) by striking ‘‘or (II)’’ and inserting ‘‘,
(II)’’; and
(B) by inserting ‘‘eligibility of a child for
medical assistance under the State plan under
this title, or eligibility of a child for child health
assistance under the program funded under
title XXI, (III) is an elementary school or sec-
ondary school, as such terms are defined in sec-
tion 14101 of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 8801), an el-
ementary or secondary school operated or sup-
ported by the Bureau of Indian Affairs, a State
child support enforcement agency, a child care
209
resource and referral agency, an organization
that is providing emergency food and shelter
under a grant under the Stewart B. McKinney
Homeless Assistance Act, or a State office or
entity involved in enrollment in the program
under this title, under part A of title IV, under
title XXI, or that determines eligibility for any
assistance or benefits provided under any pro-
gram of public or assisted housing that receives
Federal funds, including the program under
section 8 or any other section of the United
States Housing Act of 1937 (42 U.S.C. 1437 et
seq.), or (IV) any other entity the State so
deems, as approved by the Secretary’’ before
the semicolon.
(2) APPLICATION UNDER SCHIP.—
(A) IN GENERAL.—Section 2107(e)(1) (42
U.S.C. 1397gg(e)(1)) is amended by adding at
the end the following new subparagraph:
‘‘(D) Section 1920A (relating to presump-
tive eligibility).’’.
(B) EXCEPTION FROM LIMITATION ON AD-
MINISTRATIVE EXPENSES.—Section 2105(c)(2)
(42 U.S.C. 1397ee(c)(2)) is amended by adding
at the end the following new subparagraph:
210
‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI-
GIBILITY
EXPENDITURES.—The 
limitation
under subparagraph (A) on expenditures shall
not apply to expenditures attributable to the
application of section 1920A (pursuant to sec-
tion 2107(e)(1)(D)), regardless of whether the
child is determined to be ineligible for the pro-
gram under this title or title XIX.’’.
(3) TECHNICAL AMENDMENTS.—Section 1920A
(42 U.S.C. 1396r–1a) is amended—
(A) in subsection (b)(3)(A)(ii), by striking
‘‘paragraph (1)(A)’’ and inserting ‘‘paragraph
(2)(A)’’; and
(B) in subsection (c)(2), in the matter pre-
ceding subparagraph (A), by striking ‘‘sub-
section (b)(1)(A)’’ and inserting ‘‘subsection
(b)(2)(A)’’.
(b) ELIMINATION OF SCHIP FUNDING OFFSET FOR
EXERCISE OF PRESUMPTIVE ELIGIBILITY OPTION.—
(1) IN GENERAL.—Section 2104(d) (42 U.S.C.
1397dd(d)) is amended by striking ‘‘the sum of—’’
and all that follows through ‘‘(2)’’ and conforming
the margins of all that remains accordingly.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) takes effect October 1, 2000, and
211
applies to allotments under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) for fiscal
year 2001 and each succeeding fiscal year there-
after.
SEC. 705. IMPROVEMENTS TO THE MATERNAL AND CHILD
HEALTH SERVICES BLOCK GRANT.
(a) INCREASE IN AUTHORIZATION OF APPROPRIA-
TIONS.—Section 501(a) (42 U.S.C. 701(a)) is amended in
the 
matter 
preceding 
paragraph 
(1) 
by 
striking
‘‘$705,000,000 for fiscal year 1994’’ and inserting
‘‘$1,000,000,000 for fiscal year 2001’’.
(b) COORDINATION WITH MEDICAID AND SCHIP.—
(1) SCHIP.—Section 505(a)(5)(F) (42 U.S.C.
705(a)(5)(F)) is amended—
(A) in clause (ii), by inserting ‘‘and in the
coordination of the administration of the State
program under title XXI with the care and
services available under this title, as required
under subsections (b)(3)(G) and (c)(2) of sec-
tion 2102’’ before the comma; and
(B) in clause (iv), by striking ‘‘and infants
who are eligible for medical assistance under
subparagraph (A) or (B) of section 1902(l)(1)’’
and inserting ‘‘, infants, and children who are
eligible for medical assistance under section
212
1902(l)(1), and children who are eligible for
child health assistance under the State program
under title XXI’’.
(2) CONFORMING
AMENDMENTS
TO
SCHIP.—
Section 2102(b)(3) (42 U.S.C. 1397bb(b)(3)), as
amended by section 703(b)(2), is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (E);
(B) by striking the period at the end of
subparagraph (F) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subparagraph:
‘‘(G) that operations and activities under
this title are developed and implemented in con-
sultation and coordination with the program op-
erated by the State under title V with respect
to outreach and enrollment, benefits and serv-
ices, service delivery standards, public health
and social service agency relationships, and
quality assurance and data reporting.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section take effect on October 1, 2000.
213
SEC. 706. IMPROVING ACCESS TO MEDICARE COST-SHAR-
ING ASSISTANCE FOR LOW-INCOME BENE-
FICIARIES.
(a) INCREASE IN SLMB ELIGIBILITY.—
(1) IN GENERAL.—Section 1902(a)(10)(E) (42
U.S.C. 1396a(a)(10)(E)) is amended—
(A) in clause (iii), by striking ‘‘and 120
percent in 1995’’ and inserting ‘‘, 120 percent
in 1995 through 2000, and 135 percent in
2001’’; and
(B) in clause (iv), by striking ‘‘2002)—’’
and all that follows through ‘‘(II) for’’ and in-
serting ‘‘2002) for’’.
(2) 
CONFORMING
AMENDMENT.—Section
1933(c)(2)(A) (42 U.S.C. 1396u–3(c)(2)(A)) is
amended by striking ‘‘sum of—’’ and all that follows
through ‘‘(ii) the’’’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection take effect on January 1, 2001,
and with respect to the amendment made by para-
graph (2), applies to allocations determined under
section 1933(c) of the Social Security Act (42
U.S.C. 1396u–3(c)) for the last 3 quarters of fiscal
year 2001 and all of fiscal year 2002.
(b) INDEX OF ASSETS TEST TO INFLATION.—Section
1905(p)(1)(C) (42 U.S.C. 1396d(p)(1)(C)) is amended by
214
inserting ‘‘, increased (beginning with 2001 and each year
thereafter) by the percentage increase (if any) in the Con-
sumer Price Index for All Urban Consumers (United
States city average)’’ before the period.
(c) INCREASED EFFORT TO PROVIDE MEDICARE
BENEFICIARIES WITH MEDICARE COST-SHARING UNDER
THE MEDICAID PROGRAM.—
(1) IN GENERAL.—Section 1902(a) (42 U.S.C.
1396a(a)), as amended by section 703(b)(1)(A), is
amended—
(A) in paragraph (65), by striking ‘‘and’’
at the end;
(B) in paragraph (66), by striking the pe-
riod and inserting ‘‘; and’’; and
(C) by inserting after paragraph (66) the
following new paragraph:
‘‘(67) provide for the determination of eligibility
for medicare cost-sharing (as defined in section
1905(p)(3)) for individuals described in paragraph
(10)(E) and, if eligible for such medicare cost-shar-
ing, for the enrollment of such individuals at any
hospital, clinic, or similar entity at which State or
local agency personnel are stationed for the purpose
of determining the eligibility of individuals for med-
ical assistance under the State plan or providing
215
outreach services to eligible or potentially eligible in-
dividuals.’’.
(2) EFFECTIVE DATE.—The amendments made
by this paragraph shall take effect on the date of en-
actment of this Act.
(d) PRESUMPTIVE ELIGIBILITY OF CERTAIN LOW-IN-
COME
INDIVIDUALS
FOR
MEDICARE
COST-SHARING
UNDER THE QMB OR SLMB PROGRAM.—Title XIX (42
U.S.C. 1396 et seq.) is amended by inserting after section
1920A the following new section:
‘‘PRESUMPTIVE ELIGIBILITY OF CERTAIN LOW-INCOME
INDIVIDUALS
‘‘SEC. 1920B. (a) A State plan approved under sec-
tion 1902 shall provide for making medical assistance with
respect to medicare cost-sharing covered under the State
plan available to a low-income individual on the date the
low-income individual becomes entitled to benefits under
part A of title XVIII during a presumptive eligibility pe-
riod.
‘‘(b) For purposes of this section:
‘‘(1) The term ‘low-income individual’ means an
individual who at the age of 65 years is described—
‘‘(A) in section 1902(a)(10)(E)(i), or
‘‘(B) in section 1902(a)(10)(E)(iii).
‘‘(2) The term ‘medicare cost-sharing’—
216
‘‘(A) with respect to an individual de-
scribed in paragraph (1)(A), has the meaning
given such term in section 1905(p)(3); and
‘‘(B) with respect to an individual de-
scribed in paragraph (1)(B), has the meaning
given such term in section 1905(p)(3)(A).
‘‘(3) The term ‘presumptive eligibility period’
means, with respect to a low-income individual, the
period that—
‘‘(A) begins with the date on which a
qualified entity determines, on the basis of pre-
liminary information, that the income and re-
sources of the individual do not exceed the ap-
plicable income and resource level of eligibility
under the State plan, and
‘‘(B) ends with (and includes) the earlier
of—
‘‘(i) the day on which a determination
is made with respect to the eligibility of
the low-income individual for medical as-
sistance for medical cost-sharing under the
State plan, or
‘‘(ii) in the case of a low-income indi-
vidual on whose behalf an application is
not filed by the last day of the month fol-
217
lowing the month during which the entity
makes the determination referred to in
subparagraph (A), such last day.
‘‘(4)(A) Subject to subparagraph (B), the term
‘qualified entity’ means any of the following:
‘‘(i) Qualified individuals within the Social
Security Administration.
‘‘(ii) An entity determined by the State
agency to be capable of making determinations
of the type described in paragraph (3).
‘‘(B) The Secretary may issue regulations fur-
ther limiting those entities that may become quali-
fied entities in order to prevent fraud and abuse and
for other reasons.
‘‘(c)(1) The State agency, after consultation with the
Secretary, shall provide qualified entities with—
‘‘(A) such forms as are necessary for an appli-
cation to be made on behalf of a low-income indi-
vidual for medical assistance for medical cost-shar-
ing under the State plan, and
‘‘(B) information on how to assist low-income
individuals and other persons in completing and fil-
ing such forms.
‘‘(2) A qualified entity that determines under sub-
section (b)(2)(A) that a low-income individual is presump-
218
tively eligible for medical assistance for medical cost-shar-
ing under a State plan shall—
‘‘(A) notify the State agency of the determina-
tion within 5 working days after the date on which
the determination is made, and
‘‘(B) inform the low-income individual at the
time the determination is made that an application
for medical assistance for medical cost-sharing 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) In the case of a low-income individual who is
determined by a qualified entity to be presumptively eligi-
ble for medical assistance for medical cost-sharing under
a State plan, the low-income individual shall make applica-
tion for medical assistance for medical cost-sharing under
such plan by not later than the last day of the month fol-
lowing the month during which the determination is made.
‘‘(d) Notwithstanding any other provision of this title,
medical assistance for medicare cost-sharing that—
‘‘(1) is furnished to a low-income individual
during a presumptive eligibility period under the
State plan; and
‘‘(2) is included in the services covered by a
State plan;
219
shall be treated as medical assistance provided by such
plan for purposes of section 1903.’’.
SEC. 707. BREAST AND CERVICAL CANCER PREVENTION
AND TREATMENT.
(a) 
COVERAGE
AS
OPTIONAL
CATEGORICALLY
NEEDY GROUP.—
(1) IN
GENERAL.—Section 1902(a)(10)(A)(ii)
(42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—
(A) in subclause (XVI), by striking ‘‘or’’ at
the end;
(B) in subclause (XVII), by adding ‘‘or’’ at
the end; and
(C) by adding at the end the following:
‘‘(XVIII) who are described in
subsection (aa) (relating to certain
breast or cervical cancer patients);’’.
(2) GROUP
DESCRIBED.—Section 1902 (42
U.S.C. 1396a) is amended by adding at the end the
following:
‘‘(aa) Individuals described in this subsection are in-
dividuals who—
‘‘(1) 
are 
not 
described 
in 
subsection
(a)(10)(A)(i);
‘‘(2) have not attained age 65;
220
‘‘(3) have been screened for breast and cervical
cancer under the Centers for Disease Control and
Prevention breast and cervical cancer early detection
program established under title XV of the Public
Health Service Act (42 U.S.C. 300k et seq.) in ac-
cordance with the requirements of section 1504 of
that Act (42 U.S.C. 300n) and need treatment for
breast or cervical cancer; and
‘‘(4) are not otherwise covered under creditable
coverage, as defined in section 2701(c) of the Public
Health Service Act (42 U.S.C. 300gg(c)).’’.
(3) 
LIMITATION
ON
BENEFITS.—Section
1902(a)(10) (42 U.S.C. 1396a(a)(10)) is amended
in the matter following subparagraph (G)—
(A) by striking ‘‘and (XIII)’’ and inserting
‘‘(XIII)’’; and
(B) by inserting ‘‘, and (XIV) 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)(XVIII) shall be limited to
medical assistance provided during the period in
which such an individual requires treatment for
breast or cervical cancer’’ before the semicolon.
221
(4) 
CONFORMING
AMENDMENTS.—Section
1905(a) (42 U.S.C. 1396d(a)) is amended in the
matter preceding paragraph (1)—
(A) in clause (xi), by striking ‘‘or’’ at the
end;
(B) in clause (xii), by adding ‘‘or’’ at the
end; and
(C) by inserting after clause (xii) the fol-
lowing:
‘‘(xiii) 
individuals 
described 
in 
section
1902(aa),’’.
(b) PRESUMPTIVE ELIGIBILITY.—
(1) IN GENERAL.—Title XIX (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 med-
ical assistance available to an individual described in sec-
tion 1902(aa) (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-
222
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); 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
223
‘‘(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
224
(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 the 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; and
225
‘‘(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 clause (4) of the first sentence of
section 1905(b).’’.
(2) CONFORMING AMENDMENTS.—
(A) 
Section 
1902(a)(47) 
(42 
U.S.C.
1396a(a)(47)) is amended by inserting before
the semicolon at the end the following: ‘‘and
provide for making medical assistance available
to individuals described in subsection (a) of sec-
tion 1920B during a presumptive eligibility pe-
riod in accordance with such section’’.
(B) Section 1903(u)(1)(D)(v) (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-
section (a) of section 1920B during a pre-
sumptive eligibility period under such sec-
tion’’.
226
(c) ENHANCED MATCH.—The first sentence of sec-
tion 1905(b) (42 U.S.C. 1396d(b)) is amended—
(1) by striking ‘‘and’’ before ‘‘(3)’’; and
(2) by inserting before the period at the end the
following: ‘‘, and (4) the Federal medical assistance
percentage shall be equal to the enhanced FMAP de-
scribed in section 2105(b) with respect to medical
assistance provided to individuals who are eligible
for such assistance only on the basis of section
1902(a)(10)(A)(ii)(XVIII)’’.
(d) EFFECTIVE DATE.—The amendments made by
this section apply to medical assistance for items and serv-
ices furnished on or after October 1, 2000, without regard
to whether final regulations to carry out such amendments
have been promulgated by such date.
SEC. 708. MEDICAID COVERAGE OF SERVICES FURNISHED
BY CERTIFIED NURSE PRACTITIONERS AND
CLINICAL NURSE SPECIALISTS.
(a) IN GENERAL.—Section 1905(a)(21) (42 U.S.C.
1396d(a)(21)) is amended to read as follows:
‘‘(21) services furnished by a certified nurse
practitioner (as defined by the Secretary) or a clin-
ical nurse specialist (as defined in subsection (x)
which the certified nurse practitioner or clinical
nurse specialist is legally authorized to perform
227
under State law (or the State regulatory mechanism
provided by State law), whether or not the certified
nurse practitioner or clinical nurse specialist is
under the supervision of, or associated with, a physi-
cian or other health care provider;’’.
(b) DEFINITION OF CLINICAL NURSE SPECIALIST.—
Section 1905 of such Act (42 U.S.C. 1396d) is amended
by adding at the end the following new subsection:
‘‘(x) The term ‘clinical nurse specialist’ means an in-
dividual who has earned a master’s degree in a clinical
area of nursing from an accredited institution and who
is a registered nurse licensed to practice nursing in the
State in which the individual furnishes services.’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) apply to calendar quarters begin-
ning on or after October 1, 2000, without regard to wheth-
er or not final regulations to carry out such amendments
have been promulgated by such date.
TITLE VIII—OTHER PROVISIONS
SEC. 801. APPROPRIATIONS FOR RICKY RAY HEMOPHILIA
RELIEF FUND.
Section 101(e) of the Ricky Ray Hemophilia Relief
Fund Act of 1998 (42 U.S.C. 300c–22 note) is amended
by adding at the end the following: ‘‘There is appropriated
228
to the Fund $475,000,000 for fiscal year 2001, to remain
available until expended.’’.
SEC. 802. INCREASE IN APPROPRIATIONS FOR SPECIAL DI-
ABETES PROGRAMS FOR CHILDREN WITH
TYPE I DIABETES AND INDIANS.
(a) SPECIAL DIABETES PROGRAMS FOR CHILDREN
WITH TYPE I DIABETES.—Section 330B(b) of the Public
Health Service Act (42 U.S.C. 254c–2(b)) is amended—
(1) by striking ‘‘Notwithstanding’’ and insert-
ing the following:
‘‘(1) 
TRANSFERRED
FUNDS.—Notwith-
standing’’; and
(2) by adding at the end the following:
‘‘(2) APPROPRIATIONS.—For the purpose of
making grants under this section, there are appro-
priated, out of any money in the Treasury not other-
wise appropriated—
‘‘(A) $70,000,000 for each of fiscal years
2001 and 2002 (which shall be combined with
amounts transferred under paragraph (1) for
each such fiscal years); and
‘‘(B) $100,000,000 for each of fiscal years
2003 through 2005.’’.
229
(b) SPECIAL DIABETES PROGRAMS FOR INDIANS.—
Section 330C(c) of the Public Health Service Act (42
U.S.C. 254c–3(c)) is amended—
(1) by striking ‘‘Notwithstanding’’ and insert-
ing the following:
‘‘(1) 
TRANSFERRED
FUNDS.—Notwith-
standing’’;
(2) by adding at the end the following:
‘‘(2) APPROPRIATIONS.—For the purpose of
making grants under this section, there are appro-
priated, out of any money in the Treasury not other-
wise appropriated—
‘‘(A) $70,000,000 for each of fiscal years
2001 and 2002 (which shall be combined with
amounts transferred under paragraph (1) for
each such fiscal years); and
‘‘(B) $100,000,000 for each of fiscal years
2003 through 2005.’’.
SEC. 803. DEMONSTRATION GRANTS TO IMPROVE OUT-
REACH, ENROLLMENT, AND COORDINATION
OF PROGRAMS AND SERVICES TO HOMELESS
INDIVIDUALS AND FAMILIES.
(a) AUTHORITY.—The Secretary of Health and
Human Services may award demonstration grants to not
more than 7 States (or other qualified entities) to conduct
230
innovative programs that are designed to improve out-
reach to homeless individuals and families under the pro-
grams described in subsection (b) with respect to enroll-
ment of such individuals and families under such pro-
grams and the provision of services (and coordinating the
provision of such services) under such programs.
(b) PROGRAMS FOR HOMELESS DESCRIBED.—The
programs described in this subsection are as follows:
(1) MEDICAID.—The program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.).
(2) SCHIP.—The program under title XXI of
such Act (42 U.S.C. 1397aa et seq.).
(3) TANF.—The program under part of A of
title IV of such Act (42 U.S.C. 601 et seq.).
(4) MATERNAL
AND
CHILD
HEALTH
BLOCK
GRANTS.—The program under title V of the Social
Security Act (42 U.S.C. 701 et seq.).
(5) MENTAL HEALTH AND SUBSTANCE ABUSE
BLOCK GRANTS.—The program under part B of title
XIX of the Public Health Service Act (42 U.S.C.
300x–1 et seq.).
(6) HIV/AIDS CARE
GRANTS.—The program
under part B of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff–21 et seq.).
231
(7) FOOD
STAMP
PROGRAM.—The program
under the Food Stamp Act of 1977 (7 U.S.C. 2011
et seq.).
(8) WORKFORCE INVESTMENT ACT.—The pro-
gram under the Workforce Investment Act of 1999
(29 U.S.C. 2801 et seq.).
(9) WELFARE-TO-WORK.—The welfare-to-work
program under section 403(a)(5) of the Social Secu-
rity Act (42 U.S.C. 603(a)(5)).
(10) OTHER PROGRAMS.—Other public and pri-
vate benefit programs that serve low-income individ-
uals.
(c) APPROPRIATIONS.—For the purposes of carrying
out this section, there are appropriated, out of any funds
in the Treasury not otherwise appropriated, $10,000,000,
to remain available until expended.
SEC. 804. PROTECTION OF AN HMO ENROLLEE TO RECEIVE
CONTINUING CARE AT A FACILITY SELECTED
BY THE ENROLLEE.
(a) AMENDMENTS TO THE EMPLOYEE RETIREMENT
INCOME SECURITY ACT OF 1974.—
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185 et seq.) is
232
amended by adding at the end the following new sec-
tion:
‘‘SEC. 714. ENSURING CHOICE FOR CONTINUING CARE.
‘‘(a) IN GENERAL.—With respect to health insurance
coverage provided to participants or beneficiaries through
a managed care organization under a group health plan,
or through a health insurance issuer providing health in-
surance coverage in connection with a group health plan,
such plan or issuer may not deny coverage for services
provided to such participant or beneficiary by a continuing
care retirement community, skilled nursing facility, or
other qualified facility in which the participant or bene-
ficiary resided prior to a hospitalization, regardless of
whether such organization is under contract with such
community or facility if the requirements described in sub-
section (b) are met.
‘‘(b) REQUIREMENTS.—The requirements of this sub-
section are that—
‘‘(1) the service involved is a service for which
the managed care organization involved would be re-
quired to provide or pay for under its contract with
the participant or beneficiary if the continuing care
retirement community, skilled nursing facility, or
other qualified facility were under contract with the
organization;
233
‘‘(2) the participant or beneficiary involved—
‘‘(A) resided in the continuing care retire-
ment community, skilled nursing facility, or
other qualified facility prior to being hospital-
ized;
‘‘(B) had a contractual or other right to
return to the facility after hospitalization; and
‘‘(C) elects to return to the facility after
hospitalization, whether or not the residence of
the participant or beneficiary after returning
from the hospital is the same part of the facility
in which the beneficiary resided prior to hos-
pitalization;
‘‘(3) the continuing care retirement community,
skilled nursing facility, or other qualified facility has
the capacity to provide the services the participant
or beneficiary needs; and
‘‘(4) the continuing care retirement community,
skilled nursing facility, or other qualified facility is
willing to accept substantially similar payment under
the same terms and conditions that apply to simi-
larly situated health care facility providers under
contract with the organization involved.
‘‘(c) SERVICES TO PREVENT HOSPITALIZATION.—A
group health plan or health insurance issuer to which this
234
section applies may not deny payment for a skilled nursing
service provided to a participant or beneficiary by a con-
tinuing care retirement community, skilled nursing facil-
ity, or other qualified facility in which the participant or
beneficiary resides, without a preceding hospital stay, re-
gardless of whether the organization is under contract
with such community or facility, if—
‘‘(1) the plan or issuer has determined that the
service is necessary to prevent the hospitalization of
the participant or beneficiary; and
‘‘(2) the service to prevent hospitalization is
provided as an additional benefit as described in sec-
tion 417.594 of title 42, Code of Federal Regula-
tions, and would otherwise be covered as provided
for in subsection (b)(1).
‘‘(d) RIGHTS OF SPOUSES.—A group health plan or
health insurance issuer to which this section applies shall
not deny payment for services provided by a skilled nurs-
ing facility for the care of a participant or beneficiary, re-
gardless of whether the plan or issuer is under contract
with such facility, if the spouse of the participant or bene-
ficiary is already a resident of such facility and the re-
quirements described in subsection (b) are met.
‘‘(e) EXCEPTIONS.—Subsection (a) shall not apply—
235
‘‘(1) where the attending acute care provider
and the participant or beneficiary (or a designated
representative of the participant or beneficiary where
the participant or beneficiary is physically or men-
tally incapable of making an election under this
paragraph) do not elect to pursue a course of treat-
ment necessitating continuing care; or
‘‘(2) unless the community or facility involved—
‘‘(A) meets all applicable licensing and cer-
tification requirements of the State in which it
is located; and
‘‘(B) agrees to reimbursement for the care
of the participant or beneficiary at a rate simi-
lar to the rate negotiated by the managed care
organization with similar providers of care for
similar services.
‘‘(f) PROHIBITIONS.—A group health plan and a
health insurance issuer providing health insurance cov-
erage in connection with a group health plan may not—
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage with a
managed care organization under the plan, solely for
the purpose of avoiding the requirements of this sec-
tion;