I
106TH CONGRESS
2D SESSION
H. R. 4743
To amend the Social Security Act to improve access to prescription drugs
for low-income Medicare beneficiaries, the Internal Revenue Code and
other Acts to improve access to health care coverage for seniors, the
self-employed, and children, and to amend the Federal Food, Drug,
and Cosmetic Act to improve meaningful access to reasonably priced
prescription drugs.
IN THE HOUSE OF REPRESENTATIVES
JUNE 26, 2000
Mr. GANSKE introduced the following bill; which was referred to the Com-
mittee on Commerce, and in addition to the Committee on Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned
A BILL
To amend the Social Security Act to improve access to pre-
scription drugs for low-income Medicare beneficiaries, the
Internal Revenue Code and other Acts to improve access
to health care coverage for seniors, the self-employed,
and children, and to amend the Federal Food, Drug,
and Cosmetic Act to improve meaningful access to rea-
sonably priced prescription drugs.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Drug Availability and Health Care Access Improvement
Act of 2000’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—MEDICAID PRESCRIPTION DRUG COVERAGE FOR LOW-
INCOME MEDICARE BENEFICIARIES
Sec. 101. Medicaid prescription drug coverage for low-income medicare bene-
ficiaries.
TITLE II—IMPROVED ACCESS OF AMERICANS TO HEALTH
INSURANCE COVERAGE
Subtitle A—Access of Medicare Beneficiaries to Medicare+Choice Plans
Sec. 201. Improved access to Medicare+Choice plans through an increase in
the minimum Medicare+Choice capitation rate.
Subtitle B—Access of the Self-Employed
Sec. 211. Deduction for 100 percent of health insurance costs of self-employed
individuals.
Subtitle C—Improve the Coverage of Needy Children under the State
Children’s Health Insurance Program (SCHIP) and the Medicaid Program
Sec. 221. Simplified outreach and enrollment.
Sec. 222. Family friendly coverage and enrollment.
Sec. 223. Expanded coverage options.
TITLE III—IMPROVED ACCESS TO REASONABLY PRICED
PRESCRIPTION DRUGS
Sec. 301. Clarification of certain responsibilities of Food and Drug Administra-
tion with respect to importation of drugs into United States.
Sec. 302. Increased consumer information in prescription drug advertising.
Sec. 303. Education about manufacturer programs for free drugs to patients.
Sec. 304. Sense of Congress regarding manufacturer pricing practices.
TITLE I—MEDICAID PRESCRIP-
TION DRUG COVERAGE FOR
LOW-INCOME 
MEDICARE
BENEFICIARIES
SEC. 101. MEDICAID PRESCRIPTION DRUG COVERAGE FOR
LOW-INCOME MEDICARE BENEFICIARIES.
(a) IN GENERAL.—Section 1902(a)(10) of the Social
Security Act (42 U.S.C. 1396a(a)(10)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (F);
(2) by adding ‘‘and’’ at the end of subpara-
graph (G); and
(3) by inserting after subparagraph (G) the fol-
lowing new subparagraph:
‘‘(H) for making medical assistance avail-
able for prescribed drugs (in the same amount,
duration, and scope as for individuals described
in subparagraph (A)) for qualified medicare
beneficiaries described in section 1905(p)(1)
and for individuals who would be such qualified
medicare beneficiaries but for the fact that
their income exceeds the income level estab-
lished by the State under section 1905(p)(2)
but is less than 175 percent of the official pov-
erty line (referred to in such section) for a fam-
ily of the size involved;’’.
(b) 100 PERCENT FEDERAL FINANCING OF ADDI-
TIONAL COSTS.—Section 1903(a) of such Act (42 U.S.C.
1396b(a)) is amended—
(1) by redesignating paragraph (7) as para-
graph (8); and
(2) by adding after paragraph (6) the following
new paragraph:
‘‘(7) an amount equal to 100 percent of
amounts as expended as medical assistance for pre-
scribed drugs described in section 1902(a)(10)(H) to
individuals who are eligible for such assistance only
on the basis of such section; and’’.
(c) PERMITTING CHARGING OF SLIDING SCALE PRE-
MIUMS FOR QUALIFYING INDIVIDUALS WITH INCOMES
ABOVE 135 PERCENT OF POVERTY LINE.—Section 1916
of such Act is amended—
(1) in subsection (b), by striking ‘‘or (E)’’ and
inserting ‘‘, (E), or (H)’’; and
(2) in subsection (d)—
(A) by inserting ‘‘(1)’’ after ‘‘(d)’’, and
(B) by adding at the end the following new
paragraph:
‘‘(2)(A) With respect to an individual described in
section 1902(a)(10)(H) whose income (as determined
under section 1905(p)(1)(B)) exceeds 135 percent of the
official poverty line referred to in that section, the State
plan of a State shall provide for the charging of a premium
(expressed as a percentage of the average actuarial cost
of the benefits described in section 1902(a)(10)(H) pro-
vided with respect to individuals described in such section)
according to a sliding scale under which such percentage
increases from 0 percent to 100 percent, in reasonable in-
crements (as determined by the Secretary), as the individ-
ual’s income increases from 135 percent of such poverty
line to 175 percent of such poverty line.
‘‘(B) A State shall not require prepayment of a pre-
mium imposed pursuant to subparagraph (A) and shall
not terminate eligibility of an individual for medical assist-
ance under this title on the basis of failure to pay any
such premium until such failure continues for a period of
not less than 60 days. The State may waive payment of
any such premium in any case where the State determines
that requiring such payment would create an undue hard-
ship.
‘‘(C) A State may permit State or local funds avail-
able under other programs to be used for payment of a
premium imposed under subparagraph (A). Payment of
a premium with such funds shall not be counted as income
to the individual with respect to whom such payment is
made.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section take effect on January 1, 2001.
TITLE II—IMPROVED ACCESS OF
AMERICANS TO HEALTH IN-
SURANCE COVERAGE
Subtitle 
A—Access 
of 
Medicare
Beneficiaries 
to
Medicare+Choice Plans
SEC. 201. IMPROVED ACCESS TO MEDICARE+CHOICE PLANS
THROUGH AN INCREASE IN THE MINIMUM
MEDICARE+CHOICE CAPITATION RATE.
(a) IN GENERAL.—Section 1853(c)(1)(B)(ii) of the
Social Security Act (42 U.S.C. 1395w–23(c)(1)(B)(ii)) is
amended—
(1) by striking ‘‘(ii) For a succeeding year’’ and
inserting ‘‘(ii)(I) Subject to subclause (II), for a suc-
ceeding year’’; and
(2) by adding at the end the following new sub-
clause:
‘‘(II) For 2001 for any of the 50
States and the District of Columbia,
$600.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply to years beginning with 2001.
Subtitle B—Access of the Self-
Employed
SEC. 211. DEDUCTION FOR 100 PERCENT OF HEALTH IN-
SURANCE COSTS OF SELF-EMPLOYED INDI-
VIDUALS.
(a) IN GENERAL.—Paragraph (1) of section 162(l)
of the Internal Revenue Code of 1986 is amended to read
as follows:
‘‘(1) ALLOWANCE OF DEDUCTION.—In the case
of an individual who is an employee within the
meaning of section 401(c)(1), there shall be allowed
as a deduction under this section an amount equal
to 100 percent of the amount paid during the tax-
able year for insurance which constitutes medical
care for the taxpayer and the taxpayer’s spouse and
dependents.’’.
(b) CLARIFICATION OF LIMITATIONS ON OTHER COV-
ERAGE.—The first sentence of section 162(l)(2)(B) of
such Code is amended to read as follows: ‘‘Paragraph (1)
shall not apply to any taxpayer for any calendar month
for which the taxpayer participates in any subsidized
health plan maintained by any employer (other than an
employer described in section 401(c)(4)) of the taxpayer
or the spouse of the taxpayer.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to taxable years beginning after
December 31, 1999.
Subtitle C—Improve the Coverage
of Needy Children under the
State Children’s Health Insur-
ance Program (SCHIP) and the
Medicaid Program
SEC. 221. SIMPLIFIED OUTREACH AND ENROLLMENT.
(a) USE OF UNIFORM APPLICATION AND COORDI-
NATED ENROLLMENT PROCESS.—
(1) SCHIP PROGRAM.—Section 2102 of the So-
cial Security Act (42 U.S.C. 1397bb) is amended by
adding at the end the following new subsection:
‘‘(d) DEVELOPMENT AND USE OF UNIFORM APPLI-
CATION FORMS AND COORDINATED ENROLLMENT PROC-
ESS.—A State child health plan shall provide, by not later
than the first day of the first month that begins more than
6 months after the date of the enactment of this sub-
section, for—
‘‘(1) the development and use of a uniform, sim-
plified application form which is used both for pur-
poses of establishing eligibility for benefits under
this title and also under title XIX;
‘‘(2) an enrollment process that is coordinated
with that under title XIX so that a family need only
interact with a single agency in order to determine
whether a child is eligible for benefits under this
title or title XIX; and
‘‘(3) acceptance and timely response to tele-
phone inquiries and other electronic communications
received through the national toll-free system estab-
lished under section 222 of the Drug Availability
and Health Care Access Improvement Act of 2000.’’.
(2) MEDICAID CONFORMING AMENDMENT.—
(A) IN
GENERAL.—Section 1902(a) of
such Act (42 U.S.C. 1396a(a)) is amended—
(i) by striking the period at the end of
paragraph (65) and inserting ‘‘; and’’, and
(ii) 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 6 months
after the date of the enactment of this paragraph,
in the case of a State with a State child health plan
under title XXI for—
‘‘(A) the development and use of a uni-
form, simplified application form which is used
both for purposes of establishing eligibility for
benefits under this title and also under title
XXI;
‘‘(B) establishment and operation of an en-
rollment process that is coordinated with that
under title XXI so that a family need only
interact with a single agency in order to deter-
mine whether a child is eligible for benefits
under this title or title XXI; and
‘‘(C) acceptance and timely response to
telephone inquiries and other electronic commu-
nications received through the national toll-free
system established under section 222 of the
Drug Availability and Health Care Access Im-
provement Act of 2000.’’.
(B) EFFECTIVE DATE.—The amendments
made by subparagraph (A) apply to calendar
quarters beginning more than 6 months after
the date of the enactment of this Act.
(b) NATIONAL TOLL-FREE INFORMATION LINE.—
The Secretary of Health and Human Services shall estab-
lish, in coordination with State agencies responsible for
administration of State medicaid and child health insur-
ance programs and by not later than the first day of the
first month that begins more than 6 months after the date
of the enactment of this subsection, for a national toll-
free telephone number that individuals may access to ob-
tain information on coverage of children under such pro-
grams.
(c) FINANCIAL INCENTIVES TO PROMOTE APPRO-
PRIATE ENROLLMENT.—
(1) EXPANDED AVAILABILITY OF FUNDING FOR
ADMINISTRATIVE
COSTS
RELATED
TO
OUTREACH
AND
ELIGIBILITY
DETERMINATIONS.—Section
1931(h) of the Social Security Act (42 U.S.C.
1396u–1(h)) is amended—
(A) in the matter preceding paragraph (1),
by striking ‘‘TRANSITIONAL’’ and all that fol-
lows through ‘‘COSTS’’ and inserting ‘‘IN-
CREASED FEDERAL MATCHING RATE FOR AD-
MINISTRATIVE COSTS RELATED
TO CERTAIN
OUTREACH
AND
ELIGIBILITY
DETERMINA-
TIONS’’;
(B) in paragraph (2), by inserting ‘‘either’’
after ‘‘attributable’’ and by inserting before the
period at the end the following: ‘‘or to adminis-
trative costs of determinations of the eligibility
of children and pregnant women for benefits
under the State plan under this title or title
XXI, outreach to children and pregnant women
likely to be eligible for such benefits, and such
other outreach- and eligibility-related activities
as the Secretary may approve’’;
(C) in paragraph (3), by striking ‘‘and
ending with fiscal year 2000’’; and
(D) by striking paragraph (4) and insert-
ing the following:
‘‘(4) ENCOURAGING USE OF LOCAL AND COM-
MUNITY-BASED ORGANIZATIONS IN OUTREACH AND
ENROLLMENT ACTIVITIES.—The Secretary shall es-
tablish a procedure under which, if States do not
otherwise obligate the amounts made available under
this subsection, local and community-based public or
nonprofit organizations (including local and county
governments, public health departments, community
health centers, children’s hospitals, and dispropor-
tionate share hospitals) may seek to have adminis-
trative costs relating to outreach and enrollment of
children and pregnant women under this title and
title XXI be treated as administrative costs of a
State described in section 1903(a)(7), if such orga-
nizations have the permission of the State involved.
A State may require such an organization to provide
payment of such amounts as the State would other-
wise be responsible for in order to obtain payment
under this paragraph.’’.
(2) USE OF 3 PERCENT OF SCHIP FUNDS AT 90
PERCENT FEDERAL MATCH FOR ENROLLMENT AND
OUTREACH
ACTIVITIES.—Section 2105(b) of such
Act (42 U.S.C. 1397ee(b)) is amended—
(A) by designating the matter following the
dash as a paragraph (1) with appropriate in-
dentation and with the heading ‘‘(1) IN GEN-
ERAL’’;
(B) by inserting ‘‘subject to paragraph
(2)’’ after ‘‘(a)’’;
(C) by striking ‘‘(1)’’ and ‘‘(2)’’ and in-
serting ‘‘(A)’’ and ‘‘(B)’’, respectively; and
(D) by adding at the end the following
paragraph:
‘‘(2) SPECIAL
RULE
FOR
CERTAIN
ENROLL-
MENT AND OUTREACH ACTIVITIES.—
‘‘(A) IN GENERAL.—For purposes of sub-
section (a), in the case of a State that meets
the requirement of subparagraph (B), and sub-
ject to subparagraph (C), the ‘enhanced FMAP’
is equal to 90 percent with respect to amounts
expended on enrollment and outreach activities.
‘‘(B) REQUIREMENTS.—Subparagraph (A)
shall only apply to a State if the State meets
the following requirements:
‘‘(i) NO ASSET TEST.—The State does
not impose an asset test for eligibility
under the State child health plan or under
section 1902(l) with respect to children.
‘‘(ii) 
COMPLIANCE
WITH
OUTSTATIONING REQUIREMENT.—The Sec-
retary finds that the State is providing for
the receipt and initial processing of appli-
cations of certain individuals at facilities
defined as disproportionate share hospitals
under section 1923(a)(1)(A) and Feder-
ally-qualified health centers described in
section 1905(1)(2)(B) consistent with the
requirements of section 1902(a)(55).
‘‘(iii) COMPLIANCE WITH SIMPLIFIED
OUTREACH
AND
ENROLLMENT
PROVI-
SIONS.—The Secretary finds that the State
is providing for outreach and enrollment
under this title and title XIX consistent
with the requirements of sections 2102(c),
2102(d), and 1902(a)(66).
‘‘(C) LIMITATION TO 3 PERCENT OF AN-
NUAL
ALLOTMENT.—Subparagraph (A) shall
not apply to amounts expended by a State in a
fiscal year in excess of 3 percent of the amount
of the amount of its allotment under section
2104 for that fiscal year.’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection take effect on the date of the en-
actment of this Act and apply to expenditures made
on or after the date of the enactment of this Act.
(d) ADDITIONAL ENTITIES QUALIFIED TO DETER-
MINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN-
COME CHILDREN.—Section 1920A(b)(3)(A)(i) of such Act
(42 U.S.C. 1396r–1a(b)(3)(A)(i)) is amended—
(1) by striking ‘‘or (II)’’ and inserting ‘‘, (II)’’;
and
(2) by inserting ‘‘eligibility of a child for med-
ical 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 secondary school, as such
terms are defined in section 14101 of the Elemen-
tary and Secondary Education Act of 1965 (20
U.S.C. 8801), an elementary or secondary school op-
erated or supported by the Bureau of Indian Affairs,
a State child support enforcement agency, a child
care resource and referral agency, or a State office
or private contractor that accepts applications for or
administers a program funded under part A of title
IV or that determines eligibility for any assistance
or benefits provided under any program of public or
assisted housing that receives Federal funds, includ-
ing 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’’ before the semicolon.
SEC. 222. FAMILY FRIENDLY COVERAGE AND ENROLL-
MENT.
(a) ASSURING COORDINATION OF PEDIATRIC PRO-
VIDERS WITHIN A FAMILY.—
(1) IN GENERAL.—Section 2103 of the Social
Security Act (42 U.S.C. 1397cc) is amended by add-
ing at the end the following new subsection:
‘‘(g) STEPS TAKEN TO COORDINATE PROVISION OF
PEDIATRIC CARE WITHIN A FAMILY.—To the extent a
State child health plan provides coverage other than
through providing benefits under the State’s medicaid
plan under title XIX, the State child health plan—
‘‘(1) shall specify methods being used to ensure
that children within a family who are eligible for as-
sistance under the plan are allowed to be seen by the
same pediatric provider or group of pediatric pro-
viders in a manner that permits the coordinated re-
ceipt of care by children in the same family; and
‘‘(2) shall include a description of such methods
in each annual report submitted under section
2108(a).’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) applies on the date of the enact-
ment of this Act and to reports submitted for years
beginning with 2001.
(b) REDUCTION
IN BURDEN
OF ADMINISTERING
COST-SHARING PROVISIONS.—
(1) STATE
RESPONSIBLE
FOR
ASSURING
CAP
ON
COST-SHARING
NOT
EXCEEDED.—Section
2103(e)(3) of such Act (42 U.S.C. 1397cc(e)(3)) is
amended by adding at the end the following new
subparagraph:
‘‘(C) STATE AND CONTRACTORS RESPON-
SIBLE FOR APPLYING LIMITATIONS ON COST-
SHARING.—The State child health plan shall
provide that responsibility for assuring compli-
ance with the limitations on cost-sharing under
this paragraph falls on the State and on its
contractors, and not on beneficiaries and their
families.’’.
(2) STATE OPTION OF FLAT LIMIT ON OUT-OF-
POCKET EXPENDITURES.—Section 2103(e)(3)(B) of
such Act (42 U.S.C. 1397cc(e)(3)(B)) is amended by
inserting before the period at the end the following:
‘‘(or, at the option of a State, a limiting amount
which is not greater $500)’’.
(3) EFFECTIVE DATE.—The amendment made
by paragraph (1) takes effect on the date that is 30
days after the date of the enactment of this Act.
(c) PROHIBITION OF WAITING PERIODS.—
(1) IN
GENERAL.—Section 2102(b)(1)(B) of
such Act (42 U.S.C. 1397bb(b)(1)(B)) is amended—
(A) by striking ‘‘and’’ at the end of clause
(i);
(B) by striking the period at the end of
clause (ii) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
clause:
‘‘(iii) shall not permit the use of any
mandatory waiting period (including any
such period in order to carry out para-
graph (3)(C)), unless the Secretary finds
that the imposition of such a period would
not be contrary to the provisions of this
title.’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) apply to assistance furnished on or
after the date of the enactment of this Act.
(d) GRACE PERIOD BEFORE DISENROLLMENT FOR
NONPAYMENT OF PREMIUMS.—
(1) IN GENERAL.—Section 2103(e) of such Act
(42 U.S.C. 1397ee(e)) is amended by adding at the
end the following new paragraph:
‘‘(5) DISENROLLMENT
FOR
NONPAYMENT
OF
PREMIUMS.—
‘‘(A) NOTICE
OF
NONPAYMENT.—If a
State child health plan requires the payment of
a premium for enrollment and such a premium
is not paid on a timely basis, the State shall
provide, before terminating coverage under the
plan, for—
‘‘(i) notice of nonpayment at such
time and at the beginning of the last
month of the State specified enrollment pe-
riod described in subparagraph (C) if the
premium is still unpaid at that time; and
‘‘(ii) an opportunity for a hearing and
a grace period (described in subparagraph
(B)) in which the premium may be paid
and no penalty will apply for the late pay-
ment.
‘‘(B) GRACE
PERIOD.—The grace period
under this subparagraph, in the case of non-
payment for a month—
‘‘(i) before the last month of a State
specified enrollment period described in
subparagraph (C), is for the remainder of
the State specified enrollment period; or
‘‘(ii) for the last month of such pe-
riod, is for a period of at least 1 month.
‘‘(C) STATE SPECIFIED ENROLLMENT PE-
RIOD.—For 
purposes 
of 
applying 
this
paragraph—
‘‘(i) the State child health plan shall
specify an enrollment period, which shall
be a period of at least 3 months; and
‘‘(ii) after each such enrollment period
for an individual (if coverage is not termi-
nated under the plan during such period),
a new enrollment period (of the length
specified in clause (i)) shall start again for
the individual at the end of the previously
specified enrollment period.
‘‘(D) GOOD
CAUSE
WAIVER.—The State
child health plan shall establish rules allowing
waiver for good cause of termination of enroll-
ment for nonpayment of premiums.
‘‘(E) PERMITTING APPLICATION OF WAIT-
ING
PERIOD
IN
CERTAIN
REENROLLMENT
CASES.—In the case of a child whose coverage
under a State child health plan has been termi-
nated under this paragraph for nonpayment of
premiums and whose period of coverage under
the plan without premium payment exceeded 1
month, the plan may require, as a condition of
reenrollment under the plan, a waiting period
that equals the number of months of such cov-
erage without premium payment, but in no case
may such a waiting period exceed 3 months.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) applies to disenrollments occurring
on or after the date that is 30 days after the date
of the enactment of this Act.
SEC. 223. EXPANDED COVERAGE OPTIONS.
(a) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR
SCHIP AND MEDICAID BENEFITS FOR CHILDREN LOS-
ING MEDICAID OR SCHIP ELIGIBILITY.—
(1) LOSS OF MEDICAID ELIGIBILITY.—Section
1902(a)(66) of the Social Security Act (42 U.S.C.
1396a(a)(66)), as inserted by section 221(a)(2), is
amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (B),
(B) by striking the period at the end of
subparagraph (C) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subparagraph:
‘‘(D) the automatic assessment, in the case
of a child who loses eligibility for medical assist-
ance under this title on the basis of changes in
income, assets, or age, of whether the child is
eligible for benefits under title XXI.’’.
(2) LOSS
OF
SCHIP
ELIGIBILITY.—Section
2102(b)(3) of such Act (42 U.S.C. 1397bb(b)(3)) is
amended by redesignating subparagraphs (D) and
(E) as subparagraphs (E) and (F), respectively, and
by inserting after subparagraph (C) the following
new subparagraph:
‘‘(D) that there is an automatic assess-
ment, in the case of a child who loses eligibility
for child health assistance under this title on
the basis of changes in income, assets, or age,
of whether the child is eligible for medical as-
sistance under title XIX;’’.
(3) EFFECTIVE DATE.—The amendments made
by paragraphs (1) and (2) apply to children who lose
eligibility under the medicaid program under title
XIX, or under a State child health insurance plan
under title XXI, respectively, of the Social Security
Act on or after the date that is 30 days after the
date of the enactment of this Act.
(b) OPTIONAL COVERAGE OF LOW-INCOME, UNIN-
SURED PREGNANT WOMEN UNDER
A STATE CHILD
HEALTH PLAN.—
(1) IN GENERAL.—Title XXI of the Social Se-
curity Act is amended by adding at the end the fol-
lowing new section:
‘‘SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNIN-
SURED PREGNANT WOMEN.
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any
other provision of this title, a State child health plan may
provide for coverage of pregnancy-related assistance for
targeted low-income pregnant women in accordance with
this section, but only if the State has established an in-
come eligibility level under section 1902(l)(2)(A) for
women described in section 1902(l)(1)(A) that is 185 per-
cent of the income official poverty line.
‘‘(b) DEFINITIONS.—For purposes of this section:
‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The
term ‘pregnancy-related assistance’ has the meaning
given the term child health assistance in section
2110(a) as if any reference to targeted low-income
children were a reference to targeted low-income
pregnant women, except that the assistance shall be
limited to services related to pregnancy (which in-
clude prenatal, delivery, and postpartum services)
and to other conditions that may complicate preg-
nancy and shall not include prepregnancy services
and supplies.
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT
WOMAN.—The term ‘targeted low-income pregnant
woman’ has the meaning given the term targeted
low-income child in section 2110(b) as if any ref-
erence to a child were deemed a reference to a
woman during pregnancy and through the end of the
month in which the 60-day period (beginning on the
last day of her pregnancy) ends.
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of pregnancy-related assistance to tar-
geted low-income pregnant women under subsection (a),
the following special rules apply:
‘‘(1) Any reference in this title (other than sub-
section (b)) to a targeted low income child is deemed
to include a reference to a targeted low-income preg-
nant woman.
‘‘(2) Any such reference to child health assist-
ance with respect to such women is deemed a ref-
erence to pregnancy-related assistance.
‘‘(3) Any such reference to a child is deemed a
reference to a woman during pregnancy and the pe-
riod described in subsection (b)(2).
‘‘(4) The medicaid applicable income level is
deemed a reference to the income level established
under section 1902(l)(2)(A).
‘‘(5) Subsection (a) of section 2103 (relating to
required scope of health insurance coverage) shall
not apply insofar as a State limits coverage to serv-
ices described in subsection (b)(1) and the reference
to such section in section 2105(a)(1) is deemed not
to require, in such case, compliance with the require-
ments of section 2103(a).
‘‘(6) There shall be no exclusion of benefits for
services described in subsection (b)(1) based on any
pre-existing condition and no waiting period (includ-
ing any waiting period imposed to carry out section
2102(b)(3)(C)) shall apply.
‘‘(d) NO IMPACT ON ALLOTMENTS.—Nothing in this
section shall be construed as affecting the amount of any
initial allotment provided to a State under section
2104(b).
‘‘(e) APPLICATION OF FUNDING RESTRICTIONS.—
The coverage under this section (and the funding of such
coverage) is subject to the restrictions of section 2105(c).
‘‘(f) AUTOMATIC
ENROLLMENT
FOR
CHILDREN
BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS-
SISTANCE.—Notwithstanding any other provision of this
title or title XIX, if a child is born to a targeted low-in-
come pregnant woman who was receiving pregnancy-re-
lated assistance under this section on the date of the chil-
dren’s birth, the child shall be deemed to have applied for
child health assistance under the State child health plan
and to have been found eligible for such assistance under
such plan (or, in the case of a State that provides such
assistance through the provision of medical assistance
under a plan under title XIX, to have applied for medical
assistance under such title and to have been found eligible
for such assistance under such title) on the date of such
birth and to remain eligible for such assistance until the
child attains 1 year of age so long as the child is a member
of the woman’s household and the woman remains (or
would remain if pregnant) eligible for such assistance.
During the period in which a child is deemed under the
preceding sentence to be eligible for child health or med-
ical assistance, the child health or medical assistance eligi-
bility identification number of the mother shall also serve
as the identification number of the child, and all claims
shall be submitted and paid under such number (unless
the State issues a separate identification number for the
child before such period expires).’’.
(2) STATE OPTION TO USE ENHANCED FMAP
FOR COVERAGE OF ADDITIONAL PREGNANT WOMEN
UNDER THE MEDICAID PROGRAM.—Section 1905 of
such Act (42 U.S.C. 1396d) is amended—
(A) in subsection (b), by inserting ‘‘and in
the case of a State plan that meets the condi-
tion described in subsections (u)(1) and
(u)(4)(A), with respect to expenditures de-
scribed in subsection (u)(4)(B) for the State for
a fiscal year’’ after ‘‘for a fiscal year,’’;
(B) by redesignating paragraph (4) of sub-
section (u) as paragraph (5); and
(C) by inserting after paragraph (3) of
subsection (u) the following new paragraph:
‘‘(4)(A) The condition described in this subparagraph
for a State plan is that the plan has established an income
level under section 1902(l)(2)(A) with respect to individ-
or section 421 of Public Law 104–
193, but the State may not exercise
the option of providing medical assist-
ance under this subclause with respect
to a subcategory of individuals de-
scribed in this subclause;’’.
(B) 
MEDICALLY
NEEDY.—Section
1902(a)(10)(C)(i)(I) of such Act (42 U.S.C.
1396a(a)(10)(C)(i)(I)) is amended by inserting
‘‘(and such criteria may provide for eligibility of
individuals 
described 
in 
subparagraph
(A)(ii)(XV))’’ after ‘‘medical assistance’’.
(2) CHILDREN’S
HEALTH
INSURANCE
PRO-
GRAM.—Section 2110(b) of such Act (42 U.S.C.
1397jj(b)) is amended—
(A) in paragraph (1)(A), by inserting be-
fore the semicolon ‘‘(including, at the option of
the State, a child described in paragraph
(3)(B))’’; and
(B) in paragraph (3)—
(i) by striking ‘‘SPECIAL
RULE.—’’
and inserting ‘‘SPECIAL RULES.—
‘‘(i) 
HEALTH
INSURANCE
COV-
ERAGE.—’’ by indenting the remainder of
the text accordingly; and
(ii) by adding at the end the following
new subparagraph:
‘‘(B) ELIGIBILITY FOR QUALIFIED ALIEN
CHILDREN.—For purposes of paragraph (1)(A),
a child is described in this subparagraph if—
‘‘(i) the child would be determined eli-
gible for child health assistance under this
title but for any or all of the provisions of
sections 403 and 421 of Public Law 104–
193; and
‘‘(ii) the State exercises the option to
provide medical assistance to the category
of 
individuals 
described 
in 
section
1902(a)(10)(A)(ii)(XV).’’.
(3) PROHIBITION ON SEEKING SUPPORT FROM
SPONSOR.—Section 213A(b) of the Immigration and
Nationality Act (8 U.S.C. 1183a(b)) is amended by
adding at the end the following new paragraph:
‘‘(4) EXCEPTION
FOR
CHILD
MEDICAID
OR
SCHIP
ASSISTANCE.—The preceding provisions of
this subsection shall not apply to—
‘‘(A) medical assistance furnished under
the State plan under title XIX of the Social Se-
curity Act to an individual eligible for such as-
sistance because of subclause (XV) of para-
graph (10)(A)(ii) of section 1902(a) of such Act
(42 U.S.C. 1396a(a)) or because of the ref-
erence to such subclause in paragraph (10)(C)
of such section; or
‘‘(B) child health assistance furnished
under the State child health plan under title
XXI of such Act to a child eligible for such as-
sistance because of the provisions of section
2110(b)(3)(B) 
of 
such 
Act 
(42 
U.S.C.
1397jj(b)(3)(B)).’’.
(d) CLARIFICATION OF COVERAGE UNDER VACCINE
FOR CHILDREN PROGRAM.—
(1) IN GENERAL.—Section 1928(b)(2)(A)(ii) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1396s(b)(2)(A)(ii) is amended by inserting ‘‘, except
that for purposes of this paragraph a child who is
only insured under title XXI shall be considered as
being not insured’’ after ‘‘not insured’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall take effect as if included in
the enactment of the Balanced Budget Act of 1997.
(e) ELIMINATION OF FUNDING OFFSET FOR EXER-
CISE OF PRESUMPTIVE ELIGIBILITY OPTION.—
(1) IN GENERAL.—Section 2104(d) of such Act
(42 U.S.C. 1397dd(d)) is amended by striking ‘‘shall
be reduced by the sum of’’ and all that follows
through ‘‘(2) the amount of payments under such
section’’ and inserting ‘‘shall be reduced by the
amount of payments under section 1903(a)(1)’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) first applies for allotments for fis-
cal year 2001.
(f) PROGRAM COORDINATION WITH THE MATERNAL
AND CHILD HEALTH PROGRAM (TITLE V).—
(1) IN GENERAL.—Section 2102(b)(3) of such
Act (42 U.S.C. 1397bb(b)(3)) is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (D);
(B) by striking the period at the end of
subparagraph (E) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subparagraph:
‘‘(F) 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 in areas in-
cluding outreach and enrollment, benefits and
services, service delivery standards, public
health and social service agency relationships,
and quality assurance and data reporting.’’.
(2) CONFORMING
MEDICAID
AMENDMENT.—
Section 1902(a)(11) of such Act (42 U.S.C.
1306a(a)(11)) is amended—
(A) by striking ‘‘and’’ before ‘‘(C)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (D) provide that
operations and activities under this title are de-
veloped and implemented in consultation and
coordination with the program operated by the
State under title V in areas including outreach
and enrollment, benefits and services, service
delivery standards, public health and social
service agency relationships, and quality assur-
ance and data reporting’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection take effect on January 1, 2000.
TITLE 
III—IMPROVED 
ACCESS
TO 
REASONABLY 
PRICED
PRESCRIPTION DRUGS
SEC. 301. CLARIFICATION OF CERTAIN RESPONSIBILITIES
OF FOOD AND DRUG ADMINISTRATION WITH
RESPECT TO IMPORTATION OF DRUGS INTO
UNITED STATES.
Section 801 of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 381) is amended by adding at the end the
following subsection:
‘‘(g)(1) With respect to a drug being imported or of-
fered for import into the United States, the Secretary may
not send a warning notice to a person (including a phar-
macist or wholesale importer) unless the following condi-
tions are met:
‘‘(A) The notice specifies, as applicable to the
importation of the drug, that the Secretary has
made a determination that—
‘‘(i) importation is in violation of section
801(a) because the drug is or appears to be
adulterated, misbranded, or in violation of sec-
tion 505;
‘‘(ii) importation is in violation of section
801(a) because the drug is forbidden or re-
(a) by striking ‘‘in brief summary relating to side ef-
fects’’ and inserting ‘‘in comprehensive summary relating
to side effects’’; and
(b) by inserting before ‘‘except that’’ the following:
‘‘except that the regulations shall require that such com-
prehensive summary constitute not less than 50 percent
of the content of an advertisement, and the regulations
may not exempt reminder advertisements from the re-
quirement of providing the comprehensive summary, and’’.
SEC. 303. EDUCATION ABOUT MANUFACTURER PROGRAMS
FOR FREE DRUGS TO PATIENTS.
The Secretary of Health and Human Services, acting
through the Commissioner of Food and Drugs, shall in
cooperation with manufacturers of prescription drugs
carry out activities to inform patients of the existence of
programs that are operated by such manufacturers to pro-
vide prescription drugs to patients without any charge to
the patients.
SEC. 304. SENSE OF CONGRESS REGARDING MERGERS OF
DRUG MANUFACTURERS.
It is the sense of the Congress that—
(1) the increased merger of drug manufacturers
has resulted in a decrease in price competition in the
prescription drug market and increased the potential
for collusion in setting prices; and
(2) the Antitrust Division of the Department of
Justice and the Federal Trade Commission should
give increased scrutiny to the anti-competitive effects
of such mergers.
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