321
ity has contractual or other operating arrange-
ments which are not otherwise recognized in
regulation and which were in effect on July 1,
2000, the Secretary (in close consultation with,
and with the concurrence of, the State admin-
istering agency) shall permit any such program
to continue such arrangements so long as such
arrangements are found by the Secretary and
the State to be reasonably consistent with the
objectives of the PACE program.’’.
(b) CONFORMING AMENDMENT.—Section 1934(f)(2)
(42 U.S.C. 1396u–4(f)(2)) is amended by adding at the
end the following new subparagraph:
‘‘(C) CONTINUATION
OF
MODIFICATIONS
OR WAIVERS OF OPERATIONAL REQUIREMENTS
UNDER DEMONSTRATION STATUS.—If a PACE
program operating under demonstration author-
ity has contractual or other operating arrange-
ments which are not otherwise recognized in
regulation and which were in effect on July 1
2000, the Secretary (in close consultation with,
and with the concurrence of, the State admin-
istering agency) shall permit any such program
to continue such arrangements so long as such
arrangements are found by the Secretary and
322
the State to be reasonably consistent with the
objectives of the PACE program.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall be effective as included in the enactment
of BBA.
SEC. 903. FLEXIBILITY IN EXERCISING WAIVER AUTHORITY.
In 
applying 
sections 
1894(f)(2)(B) 
and
1934(f)(2)(B) of the Social Security Act (42 U.S.C.
1395eee(f)(2)(B), 1396u–4(f)(2)(B)), the Secretary of
Health and Human Services—
(1) shall approve or deny a request for a modi-
fication or a waiver of provisions of the PACE pro-
tocol not later than 90 days after the date the Sec-
retary receives the request; and
(2) may exercise authority to modify or waive
such provisions in a manner that responds promptly
to the needs of PACE programs relating to areas of
employment and the use of community-based pri-
mary care physicians.
323
Subtitle B—Outreach to Eligible
Low-Income 
Medicare 
Bene-
ficiaries
SEC. 911. OUTREACH ON AVAILABILITY OF MEDICARE
COST-SHARING 
ASSISTANCE 
TO 
ELIGIBLE
LOW-INCOME MEDICARE BENEFICIARIES.
(a) OUTREACH.—
(1) IN GENERAL.—Title XI (42 U.S.C. 1301 et
seq.) is amended by inserting after section 1143 the
following new section:
‘‘OUTREACH EFFORTS TO INCREASE AWARENESS OF THE
AVAILABILITY OF MEDICARE COST-SHARING
‘‘SEC. 1144. (a) OUTREACH.—
‘‘(1) IN GENERAL.—The Commissioner of So-
cial Security (in this section referred to as the ‘Com-
missioner’) shall conduct outreach efforts to—
‘‘(A) identify individuals entitled to bene-
fits under the medicare program under title
XVIII who may be eligible for medical assist-
ance for payment of the cost of medicare cost-
sharing under the medicaid program pursuant
to sections 1902(a)(10)(E) and 1933; and
‘‘(B) notify such individuals of the avail-
ability of such medical assistance under such
sections.
324
‘‘(2) CONTENT
OF
NOTICE.—Any notice fur-
nished under paragraph (1) shall state that eligi-
bility for medicare cost-sharing assistance under
such sections is conditioned upon—
‘‘(A) the individual providing to the State
information about income and resources (in the
case of an individual residing in a State that
imposes an assets test for such eligibility); and
‘‘(B) meeting the applicable eligibility cri-
teria.
‘‘(b) COORDINATION WITH STATES.—
‘‘(1) IN GENERAL.—In conducting the outreach
efforts under this section, the Commissioner shall—
‘‘(A) furnish the agency of each State re-
sponsible for the administration of the medicaid
program and any other appropriate State agen-
cy with information consisting of the name and
address of individuals residing in the State that
the Commissioner determines may be eligible
for medical assistance for payment of the cost
of medicare cost-sharing under the medicaid
program pursuant to sections 1902(a)(10)(E)
and 1933; and
‘‘(B) update any such information not less
frequently than once per year.
325
‘‘(2) INFORMATION
IN
PERIODIC
UPDATES.—
The periodic updates described in paragraph (1)(B)
shall include information on individuals who are or
may be eligible for the medical assistance described
in paragraph (1)(A) because such individuals have
experienced reductions in benefits under title II.’’.
(2) AMENDMENT
TO
TITLE
XIX.—Section
1905(p) (42 U.S.C. 1396d(p)) is amended by adding
at the end the following new paragraph:
‘‘(5) For provisions relating to outreach efforts to in-
crease awareness of the availability of medicare cost-shar-
ing, see section 1144.’’.
(b) GAO REPORT.—The Comptroller General of the
United States shall conduct a study of the impact of sec-
tion 1144 of the Social Security Act (as added by sub-
section (a)(1)) on the enrollment of individuals for medi-
care cost-sharing under the medicaid program. Not later
than 18 months after the date that the Commissioner of
Social Security first conducts outreach under section 1144
of such Act, the Comptroller General shall submit to Con-
gress a report on such study. The report shall include such
recommendations for legislative changes as the Comp-
troller General deems appropriate.
326
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) shall take effect one year after the date
of the enactment of this Act.
Subtitle C—Maternal and Child
Health Block Grant
SEC. 921. INCREASE IN AUTHORIZATION OF APPROPRIA-
TIONS FOR THE MATERNAL AND CHILD
HEALTH SERVICES BLOCK GRANT.
(a) IN
GENERAL.—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 in-
serting ‘‘$850,000,000 for fiscal year 2001’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) takes effect on October 1, 2000.
Subtitle D—Diabetes
SEC. 931. INCREASE IN APPROPRIATIONS FOR SPECIAL DI-
ABETES PROGRAMS FOR TYPE I DIABETES
AND INDIANS.
(a) SPECIAL DIABETES PROGRAMS FOR TYPE I DIA-
BETES.—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
327
(2) by adding at the end the following:
‘‘(2) APPROPRIATIONS.—For the purpose of
making grants under this section, there is appro-
priated, out of any funds 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 fiscal year 2003.’’.
(b) SPECIAL DIABETES PROGRAMS FOR INDIANS.—
Section 330C(c) of such Act (42 U.S.C. 254c–3(c)) 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 is 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
328
amounts transferred under paragraph (1) for
each such fiscal years); and
‘‘(B) $100,000,000 for fiscal year 2003.’’.
(c) EXTENSION OF FINAL REPORT ON GRANT PRO-
GRAMS.—Section 4923(b)(2) of BBA is amended by strik-
ing ‘‘2002’’ and inserting ‘‘2003’’.
SEC. 932. 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
to the Fund $475,000,000 for fiscal year 2001, to remain
available until expended.’’.
Subtitle E—Nurse Staffing and
Quality Improvement Act of 2000
SEC. 941. SHORT TITLE.
This subtitle may be cited as the ‘‘Nursing Home
Staffing and Quality Improvement Act of 2000’’.
SEC. 942. GRANTS TO STATES FOR IMPROVEMENTS IN
NURSING HOME STAFFING AND QUALITY.
(a) SECRETARY’S AUTHORITY TO AWARD GRANTS.—
The Secretary shall establish a program of competitive
grants to States, in accordance with the provisions of this
section, for the purpose of improving the quality of care
furnished in nursing homes operating in the State.
329
(b) APPLICATIONS AND ELIGIBILITY FOR GRANTS.—
(1) INITIAL APPLICATION.—A State seeking a
grant to conduct a project under this section shall
submit an application containing such information
and assurances as the Secretary may require,
including—
(A) a commitment to submit annual re-
ports describing the State’s progress in increas-
ing staffing levels and making other quality im-
provements in nursing homes in the State; and
(B) a description of a plan for evaluation
of the activities carried out under the grant, in-
cluding a plan for measurement of progress to-
ward the goals and objectives of the program,
consistent with the principles of the Govern-
ment Performance and Results Act.
(2) CONSULTATION WITH PUBLIC.—Before sub-
mitting an application for a grant under this section,
States shall solicit and consider the views of mem-
bers of the public, nursing home residents or their
representatives, and other persons concerned with
the administration of nursing homes within the
State with respect to the design of the proposed
State program.
(3) ELIGIBILITY.—
330
(A) INITIAL ELIGIBILITY.—A State shall
not be eligible for a grant award under this sec-
tion unless it makes assurances satisfactory to
the Secretary that the skilled nursing facilities
(as defined in section 1819(a)) and nursing fa-
cilities (as defined in section 1919(a)) within
the State will reach or exceed the minimum
staff level described in subsection (d)(2) within
two years after enactment of this Act and will
maintain such level throughout the remainder
of the grant program.
(B) CONTINUING
ELIGIBILITY.—A State
shall not be eligible for the continuation of
grant funding under a multi-year grant under
this section unless the State demonstrates to
the Secretary’s satisfaction that it continues to
meet the requirement described in subpara-
graph (A) and has made sufficient progress in
meeting the goals described in its grant applica-
tion.
(c) USE OF GRANT FUNDS.—Funds received by a
State under this section may be provided to entities in-
cluding nursing homes, labor management partnerships,
and educational institutions, and may be used for any or
all of the following purposes:
331
(1) To enable a nursing home to recruit addi-
tional nursing staff or to retain existing nursing
staff (including through the use of reasonable finan-
cial incentives or reasonable benefit enhancements).
(2) To increase education and training of nurs-
ing staff (including designing or implementing pro-
grams to promote the career advancement of cer-
tified nurse aides).
(3) To provide bonuses to nursing homes meet-
ing State quality standards or avoiding serious qual-
ity violations for a period of one or more years.
(4) Such other nursing home staffing and qual-
ity improvement initiatives as the Secretary may ap-
prove.
(d) DISTRIBUTION OF FUNDS.—
(1) IN GENERAL.—Subject to subsection (b), in
awarding grants under this section, the Secretary
shall award no more than 25 percent of the funds
to States in which, as of the date of the enactment
of this section, skilled nursing facilities (as defined
in section 1819(a)) and nursing facilities (as defined
in section 1919(a)) have reached or exceeded the
minimum staff level specified in paragraph (2) (as
determined by the Secretary).
(2) MINIMUM NURSING HOME STAFF LEVEL.—
332
(A) IN
GENERAL.—Subject to subpara-
graph (B), for purposes of subsection (b) and
paragraph (1), the level specified in this para-
graph for a skilled nursing facility or nursing
facility is a staff level sufficient to ensure that
each resident receives from a certified nurse
aide at least 2 hours per day of direct care (in-
cluding repositioning the resident and changing
wet clothes, assisting with feeding, exercise, and
toileting, and working to enhance a resident’s
independence with respect to activities of daily
living).
(B) SECRETARY’S
AUTHORITY
TO
IN-
CREASE
MINIMUM
STAFF
LEVEL.—The Sec-
retary may establish a minimum staff level that
is higher than that specified in subparagraph
(A). Any such revised staff level shall be effec-
tive no earlier than six months after the date on
which Secretary provides notice to States of the
new requirement.
(3) MULTI-YEAR
GRANT
FUNDS.—The Sec-
retary shall award any multi-year grant under this
section from amounts appropriated (or available pur-
suant to subsection (e)(2)) for the first fiscal year
of the grant.
333
(e) APPROPRIATIONS AND AVAILABILITY OF CIVIL
MONEY PENALTY (CPM) COLLECTIONS.—
(1) APPROPRIATIONS.—There are appropriated
for all costs to the Secretary for carrying out the
program under this section $200,000,000 for each of
fiscal years 2001 through 2005, such funds to re-
main available to the Secretary through the end of
the first succeeding fiscal year.
(2) AVAILABILITY OF CMP COLLECTIONS.—In
addition to the amounts appropriated pursuant to
paragraph (1), there shall be available to the Sec-
retary for such costs for such fiscal years any
amounts deposited in the Nursing Facility Civil
Money Penalties Collection Account established
under section 4.
SEC. 943. ENHANCED NURSING FACILITY REPORTING RE-
QUIREMENTS.
(a) MEDICARE.—
(1) SUBMISSION
OF
NURSING
STAFF
LEVEL
DATA
TO
THE
SECRETARY.—Section 1819(b) (42
U.S.C. 1395i–3(b)) is amended by adding at the end
the following new paragraph:
‘‘(8) DATA ON STAFFING LEVELS.—
‘‘(A) 
SUBMISSION
TO
SECRETARY.—A
skilled nursing facility shall submit to the Sec-
334
retary, in such form and manner and at such
intervals as the Secretary may require, data
with respect to nursing staff of the facility.
Such data shall include the total number of
nursing staff hours furnished during the period
specified by the Secretary (including totals for
each shift worked during such period) by the
facility to residents for which payment is made
under section 1888(e), broken down by total
certified nurse aide hours, total licensed prac-
tical or vocational nurse hours, and total reg-
istered nurse hours, and shall also include the
average wage rate for each class of nursing
staff employed by the facility.
‘‘(B) PUBLICATION.—The Secretary shall
provide for the publication on the Internet Site
of the Department of Health and Human Serv-
ices known as Nursing Home Compare the fa-
cility-specific nursing staff information collected
pursuant to subparagraph (A). The Secretary
shall update such information periodically.’’.
(2) POSTING OF INFORMATION ON NURSING FA-
CILITY
STAFFING.—Section 1819(b) (42 U.S.C.
1395i–3(b)), as amended by paragraph (1), is fur-
335
ther amended by adding at the end the following
new paragraph:
‘‘(9) INFORMATION ON NURSE STAFFING.—
‘‘(A) IN GENERAL.—A skilled nursing fa-
cility shall post daily for each nursing unit of
the facility and for each shift the current num-
ber of licensed and unlicensed nursing staff di-
rectly responsible for resident care. The infor-
mation shall be displayed in a uniform manner
(as specified by the Secretary) and in a clearly
visible place.
‘‘(B) PUBLICATION
OF
DATA.—A skilled
nursing facility shall, upon request, make avail-
able to the public the nursing staff data de-
scribed in subparagraph (A).’’.
(3) INFORMATION CONCERNING PATIENT CLAS-
SIFICATION.—Section 1819(b)(4)(C) (42 U.S.C.
1395i–3(b)(4)(C)) is amended by adding at the end
the following new clause:
‘‘(iii) 
INFORMATION
CONCERNING
RESIDENTS.—The skilled nursing facility
shall provide the Secretary, in such form
and manner and at such intervals as the
Secretary may require, a classification of
all residents of the skilled nursing facility
336
that accords with the patient classification
system 
described 
in 
section
1888(e)(3)(B)(ii), or such successor system
as the Secretary may identify.’’.
(b) MEDICAID.—
(1) IN GENERAL.—Section 1919(b) (42 U.S.C.
1396r) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(8) DATA ON STAFFING LEVELS.—
‘‘(A) 
SUBMISSION
TO
SECRETARY.—A
nursing facility shall submit to the Secretary, in
such form and manner and at such intervals as
the Secretary may require, data with respect to
nursing staff of the facility. Such data shall in-
clude the total number of nursing staff hours
furnished during the period specified by the
Secretary (including totals for each shift
worked during such period) by the facility to
residents for which payment is made under this
title, broken down by total certified nurse aide
hours, total licensed practical or vocational
nurse hours, and total registered nurse hours,
and shall also include the average wage rate for
each class of nursing staff employed by the fa-
cility.
337
‘‘(B) PUBLICATION.—The Secretary shall
provide for the publication on the Internet Site
of the Department of Health and Human Serv-
ices known as Nursing Home Compare the fa-
cility-specific nursing staff information collected
pursuant to subparagraph (A). The Secretary
shall update such information periodically.’’.
(2) POSTING OF INFORMATION ON NURSING FA-
CILITY
STAFFING.—Section 1919(b) (42 U.S.C.
1395r(b)), as amended by paragraph (1), is further
amended by adding at the end the following new
paragraph:
‘‘(9) INFORMATION ON NURSE STAFFING.—
‘‘(A) IN
GENERAL.—A nursing facility
shall post daily for each nursing unit of the fa-
cility and for each shift the current number of
licensed and unlicensed nursing staff directly
responsible for resident care. The information
shall be displayed in a uniform manner (as
specified by the Secretary) and in a clearly visi-
ble place.
‘‘(B) PUBLICATION OF DATA.—A nursing
facility shall, upon request, make available to
the public the nursing staff data described in
subparagraph (A).’’.
338
(3) INFORMATION CONCERNING PATIENT CLAS-
SIFICATION.—Section 1919(b)(4)(C) (42 U.S.C.
1396r(b)(4)(C)) is amended by adding at the end
the following new clause:
‘‘(iv) 
INFORMATION
CONCERNING
RESIDENTS.—The nursing facility shall
provide the Secretary, in such form and
manner and at such intervals as the Sec-
retary may require, a classification of all
residents of the nursing facility that ac-
cords with the patient classification system
described in section 1888(e)(3)(B)(ii), or
such successor system as the Secretary
may identify.’’.
SEC. 944. NURSING FACILITY CIVIL MONEY PENALTY COL-
LECTIONS.
(a) ESTABLISHMENT OF NURSING FACILITY CIVIL
MONEY
PENALTY
COLLECTIONS
ACCOUNT.—Section
1128A (42 U.S.C. 1320a–7a) is amended by adding at
the end the following new subsection:
‘‘(o) ESTABLISHMENT OF NURSING FACILITY CIVIL
MONEY PENALTY COLLECTIONS ACCOUNT.—There is
hereby established an account to be known as the ‘‘Nurs-
ing Facility Civil Money Penalties Collection Account’’
(hereafter in this subsection referred to as the ‘‘Ac-
339
count’’). Notwithstanding any other provision of law, there
shall be deposited into the Account the Secretary’s share
of any civil monetary penalties collected under sections
1819 and 1919, all such amounts to be available without
fiscal year limitation for repaying the Secretary’s share
of amounts owed to nursing facilities or skilled nursing
facilities pursuant to the final sentence of sections
1819(h)(2)(B)(ii) and 1919(h)(2)(B)(ii), and for award-
ing grants under section 2 of the Nursing Home Staffing
and Quality Improvement Act of 2000.’’.
(b) 
AUTHORITY
TO
COLLECT
CMPS 
IMME-
DIATELY.—
(1) MEDICARE.—Section 1819(h)(2)(B)(ii) (42
U.S.C. 1395i–3(h)(2)(B)(ii)) is amended by insert-
ing before the final period ‘‘, except that, notwith-
standing section 1128A(c)(2) or any other provision
of law, the Secretary, upon determining that a civil
money penalty should be imposed against a skilled
nursing facility pursuant to this paragraph, shall
take immediate action to collect such penalty (except
where the Secretary finds that such action could
jeopardize the health or welfare of residents of the
skilled nursing facility). In collecting such penalty,
the Secretary may deduct the amount of the penalty
from amounts otherwise payable to the facility under
340
this title or take such other actions as the Secretary
considers appropriate. If the Secretary’s imposition
of a penalty under this paragraph is set aside, in
whole or in part, as a result of a hearing under sec-
tion 1128A(c)(2) (or an appeal therefrom) or by a
court of competent jurisdiction, and the Secretary
elects not to pursue an appeal of such judgment; or
has exhausted all appeals, the Secretary shall repay
any amount owed to the skilled nursing facility with
accrued interest.’’
(2) MEDICAID.—Section 1919(h)(3)(B)(ii) (42
U.S.C. 1396r(h)(3)(B)(ii)) is amended by inserting
before the final period ‘‘, except that, notwith-
standing section 1128A(c)(2) or any other provision
of law, the Secretary, upon determining that a civil
money penalty should be imposed against a nursing
facility pursuant to this paragraph, shall take imme-
diate action to collect the penalty (except where the
Secretary finds that such action could jeopardize the
health or welfare of residents of the nursing facility).
In collecting such penalty, the Secretary may direct
the State to deduct the amount of the penalty from
amounts otherwise payable to the nursing facility
under this title or take such other actions as the
Secretary, in consultation with the State, considers
341
appropriate. If the Secretary’s imposition of a pen-
alty under this paragraph is set aside, in whole or
in part, as a result of a hearing under section
1128A(c)(2) (or an appeal therefrom) or by a court
of competent jurisdiction, and the Secretary elects
not to pursue an appeal of such judgment, or has
exhausted all appeals, the Secretary shall repay, or
shall direct the State to repay, any amount owed to
the nursing facility with accrued interest.’’
Subtitle F—Family Opportunities
Act
SEC. 951. SHORT TITLE.
This subtitle may be cited as the ‘‘Family Oppor-
tunity Act of 2000’’.
SEC. 952. OPPORTUNITY FOR FAMILIES OF DISABLED CHIL-
DREN TO PURCHASE MEDICAID COVERAGE
FOR SUCH CHILDREN.
(a) STATE OPTION TO ALLOW FAMILIES OF DIS-
ABLED CHILDREN TO PURCHASE MEDICAID COVERAGE
FOR SUCH CHILDREN.—
(1) IN
GENERAL.—Section 1902 (42 U.S.C.
1396a), as amended by the Foster Care Independ-
ence Act of 1999 (Public Law 106–169; 113 Stat.
1822) and the Ticket to Work and Work Incentives
342
Improvement Act of 1999 (Public Law 106–170;
113 Stat. 1860), is amended—
(A) in subsection (a)(10)(A)(ii)—
(i) by striking ‘‘or’’ at the end of sub-
clause (XVI);
(ii) by adding ‘‘or’’ at the end of sub-
clause (XVII); and
(iii) by adding at the end the fol-
lowing new subclause:
‘‘(XVIII) who are disabled chil-
dren described in subsection (aa);’’;
and
(B) by adding at the end the following new
subsection:
‘‘(aa) Individuals described in this subsection are
individuals—
‘‘(1) who have not attained 18 years of age;
‘‘(2) who would be considered disabled under
section 1614(a)(3)(C) (determined without regard to
the reference to age in that section) but for having
earnings or deemed income or resources (as deter-
mined under title XVI for children) that exceed the
requirements for receipt of supplemental security in-
come benefits; and
343
‘‘(3) whose family income does not exceed such
income level as the State establishes and does not
exceed—
‘‘(A) 300 percent of the income official
poverty line (as defined by the Office of Man-
agement and Budget, 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; or
‘‘(B) such higher percent of such poverty
line as a State may establish, except that no
Federal financial participation shall be provided
under section 1903(a) for any medical assist-
ance provided to an individual who would not be
described in this subsection but for this
clause.’’.
(2) INTERACTION WITH EMPLOYER-SPONSORED
FAMILY COVERAGE.—Section 1902(aa) (42 U.S.C.
1396a(aa)), as added by paragraph (1), is amended
by adding at the end the following new paragraph:
‘‘(3)(A) If an employer of a parent of an individual
described in paragraph (1) offers family coverage under
a group health plan (as defined in section 2791(a) of the
Public Health Service Act), the State may—
344
‘‘(i) require such parent to apply for, enroll in,
and pay premiums for, such coverage as a condition
of such parent’s child being or remaining eligible for
medical 
assistance 
under 
subsection
(a)(10)(A)(ii)(XVIII) if the parent is determined eli-
gible for such coverage and the employer contributes
at least 50 percent of the total cost of annual pre-
miums for such coverage; and
‘‘(ii) if such coverage is obtained—
‘‘(I) subject to paragraph (2) of section
1916(h), reduce the premium imposed by the
State under that section (if any) in an amount
that reasonably reflects the premium contribu-
tion made by the parent for private coverage on
behalf of a child with a disability; and
‘‘(II) treat such coverage as a third party
liability under subsection (a)(25).
‘‘(B) In the case of a parent to which subparagraph
(A) applies—
‘‘(i) if the family income of such parent does
not exceed 300 percent of the income official poverty
line (referred to in paragraph (1)(C)(i)), a State
may provide for payment of any portion of the an-
nual premium for such family coverage that the par-
ent is required to pay; and
345
‘‘(ii) any payments made by the State under
clause (i) shall be considered, for purposes of section
1903(a), to be payments for medical assistance.’’.
(b) STATE OPTION TO IMPOSE INCOME-RELATED
PREMIUMS.—Section 1916 (42 U.S.C. 1396o), as amend-
ed by the Ticket to Work and Work Incentives Improve-
ment Act of 1999 (Public Law 106–170; 113 Stat. 1860),
is amended—
(1) in subsection (a), by striking ‘‘subsection
(g)’’ and inserting ‘‘subsections (g) and (h)’’; and
(2) by adding at the end the following new sub-
section:
‘‘(h)(1) With respect to disabled children provided
medical 
assistance 
under 
section
1902(a)(10)(A)(ii)(XVIII), subject to paragraph (2), a
State may (in a uniform manner for such children) require
the families of such children to pay monthly premiums set
on a sliding scale based on family income.
‘‘(2) A premium requirement imposed under para-
graph (1) may only apply to the extent that—
‘‘(A) the aggregate amount of such premium
and any premium that the parent is required to pay
for family coverage under section 1902(aa)(3)(A)(i)
does not exceed 5 percent of the family’s income;
and
346
‘‘(B) the requirement is imposed consistent with
section 1902(aa)(3)(A)(ii)(I).
‘‘(3) A State shall not require prepayment of a pre-
mium imposed pursuant to paragraph (1) and shall not
terminate 
eligibility 
of 
a 
child 
under 
section
1902(a)(10)(A)(ii)(XVIII) for medical assistance 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 from the date on which the premium became past
due. The State may waive payment of any such premium
in any case where the State determines that requiring
such payment would create an undue hardship.’’.
(c) CONFORMING AMENDMENT.—Section 1903(f)(4)
(42 U.S.C. 1396b(f)(4)) is amended in the matter pre-
ceding 
subparagraph 
(A) 
by 
inserting
‘‘1902(a)(10)(A)(ii)(XVIII),’’ 
after
‘‘1902(a)(10)(A)(ii)(XVI),’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to medical assistance for items and
services furnished on or after October 1, 2000.
347
SEC. 953. TREATMENT OF INPATIENT PSYCHIATRIC HOS-
PITAL SERVICES FOR INDIVIDUALS UNDER
AGE 21 IN HOME OR COMMUNITY-BASED
SERVICES WAIVERS.
(a) IN
GENERAL.—Section 1915(c) (42 U.S.C.
1396n(c)) is amended—
(1) in paragraph (1)—
(A) in the first sentence, by inserting ‘‘, or
inpatient psychiatric hospital services for indi-
viduals under age 21,’’ after ‘‘intermediate care
facility for the mentally retarded’’; and
(B) in the second sentence, by inserting ‘‘,
or inpatient psychiatric hospital services for in-
dividuals under age 21’’ before the period;
(2) in paragraph (2)(B), by striking ‘‘or serv-
ices in an intermediate care facility for the mentally
retarded’’ each place it appears and inserting ‘‘,
services in an intermediate care facility for the men-
tally retarded, or inpatient psychiatric hospital serv-
ices for individuals under age 21’’;
(3) by striking paragraph (2)(C) and inserting
the following:
‘‘(C) such individuals who are determined to be
likely to require the level of care provided in a hos-
pital, nursing facility, or intermediate care facility
for the mentally retarded, or inpatient psychiatric
348
hospital services for individuals under age 21, are
informed of the feasible alternatives, if available
under the waiver, at the choice of such individuals,
to the provision of inpatient hospital services, nurs-
ing facility services, services in an intermediate care
facility for the mentally retarded, or inpatient psy-
chiatric hospital services for individuals under age
21;’’; and
(4) in paragraph (7)(A)—
(A) by inserting ‘‘, or inpatient psychiatric
hospital services for individuals under age 21,’’
after ‘‘intermediate care facility for the men-
tally retarded’’; and
(B) by inserting ‘‘, or who would require
inpatient psychiatric hospital services for indi-
viduals under age 21’’ before the period.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply with respect to medical assistance
provided on or after October 1, 2000.
SEC. 954. DEMONSTRATION OF COVERAGE UNDER THE
MEDICAID PROGRAM OF CHILDREN WITH PO-
TENTIALLY SEVERE DISABILITIES.
(a) STATE APPLICATION.—A State may apply to the
Secretary of Health and Human Services (in this section
referred to as the ‘‘Secretary’’) for approval of a dem-
349
onstration project (in this section referred to as a ‘‘dem-
onstration project’’) under which up to a specified max-
imum number of children with a potentially severe dis-
ability (as defined in subsection (b)) are provided medical
assistance under the State medicaid plan under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.).
(b) CHILD WITH
A POTENTIALLY SEVERE DIS-
ABILITY DEFINED.—
(1) IN
GENERAL.—In this section, the term
‘‘child with a potentially severe disability’’ means,
with respect to a demonstration project, an indi-
vidual who—
(A) has not attained 21 years of age;
(B) has a physical or mental condition,
disease, disorder (including a congenital birth
defect or a metabolic condition), injury, or de-
velopmental disability that was incurred before
the individual attained such age; and
(C) is reasonably expected, but for the re-
ceipt of medical assistance under the State
medicaid plan, to reach the level of disability
defined under section 1614(a)(3) of the Social
Security Act (42 U.S.C. 1382c(a)(3)), (deter-
mined without regard to the reference to age in
subparagraph (C) of that section).
350
(2) EXCEPTION.—Such term does not include
an individual who would be considered disabled
under section 1614(a)(3)(C) of the Social Security
Act (42 U.S.C. 1382c(a)(3)(C)) (determined without
regard to the reference to age in that section).
(c) APPROVAL OF DEMONSTRATION PROJECTS.—
(1) IN GENERAL.—Subject to paragraph (3),
the Secretary shall approve applications under sub-
section (a) that meet the requirements of paragraph
(2) and such additional terms and conditions as the
Secretary may require. The Secretary may waive the
requirement of section 1902(a)(1) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(1)) to allow for sub-
State demonstrations.
(2) TERMS AND CONDITIONS OF DEMONSTRA-
TION PROJECTS.—The Secretary may not approve a
demonstration project under this section unless the
State provides assurances satisfactory to the Sec-
retary that the following conditions are or will be
met:
(A) 
INDEPENDENT
EVALUATION.—The
State provides for an independent evaluation of
the project to be conducted during fiscal year
2005.
351
(B) CONSULTATION
FOR
DEVELOPMENT
OF CRITERIA.—The State consults with appro-
priate pediatric health professionals in estab-
lishing the criteria for determining whether a
child has a potentially severe disability.
(C) ANNUAL REPORT.—The State submits
an annual report to the Secretary (in a uniform
form and manner established by the Secretary)
on the use of funds provided under the grant
that includes the following:
(i) Enrollment and financial statistics
on—
(I) the total number of children
with a potentially severe disability en-
rolled in the demonstration project,
disaggregated by disability;
(II) the services provided by cat-
egory or code and the cost of each
service so categorized or coded; and
(III) the number of children en-
rolled in the demonstration project
who also receive services through pri-
vate insurance.
(ii) With respect to the report sub-
mitted for fiscal year 2005, the results of
352
the 
independent 
evaluation 
conducted
under subparagraph (A).
(iii) Such additional information as
the Secretary may require.
(3) LIMITATIONS ON FEDERAL FUNDING.—
(A) APPROPRIATION.—
(i) IN GENERAL.—Out of any funds in
the Treasury not otherwise appropriated,
there is appropriated to carry out this sec-
tion $16,667,000 for each of fiscal years
2001 through 2006.
(ii) BUDGET AUTHORITY.—Clause (i)
constitutes budget authority in advance of
appropriations Acts and represents the ob-
ligation of the Federal Government to pro-
vide for the payment of the amounts ap-
propriated under clause (i).
(B) LIMITATION
ON
PAYMENTS.—In no
case may—
(i) the aggregate amount of payments
made by the Secretary to States under this
section exceed $100,000,000;
(ii) the aggregate amount of payments
made by the Secretary to States for ad-
ministrative expenses relating to the eval-
353
uations and annual reports required under
subparagraphs (A) and (C) of paragraph
(2) 
exceed 
$2,000,000 
of 
such
$100,000,000; or
(iii) payments be provided by the Sec-
retary for a fiscal year after fiscal year
2009.
(C) FUNDS ALLOCATED TO STATES.—
(i) IN GENERAL.—The Secretary shall
allocate funds to States based on their ap-
plications and the availability of funds. In
making such allocations, the Secretary
shall ensure an equitable distribution of
funds among States with large populations
and States with small populations.
(ii) AVAILABILITY.—Funds allocated
to a State under a grant made under this
section for a fiscal year shall remain avail-
able until expended.
(D) FUNDS NOT ALLOCATED TO STATES.—
Funds not allocated to States in the fiscal year
for which they are appropriated shall remain
available in succeeding fiscal years for alloca-
tion by the Secretary using the allocation for-
mula established under this section.
354
(E) PAYMENTS
TO
STATES.—The Sec-
retary shall pay to each State with a dem-
onstration project approved under this section,
from its allocation under subparagraph (C), an
amount for each quarter equal to the Federal
medical assistance percentage (as defined in
section 1905(b) of the Social Security Act (42
U.S.C. 1395d(b))) of expenditures in the quar-
ter for medical assistance provided to children
with a potentially severe disability.
(d) RECOMMENDATION.—Not later than October 1,
2004, the Secretary shall submit a recommendation to the
Committee on Commerce of the House of Representatives
and the Committee on Finance of the Senate regarding
whether the demonstration project established under this
section should be continued after fiscal year 2006.
(e) STATE DEFINED.—In this section, the term
‘‘State’’ has the meaning given such term for purposes of
title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.).
SEC. 955. DEVELOPMENT AND SUPPORT OF FAMILY-TO-
FAMILY HEALTH INFORMATION CENTERS.
Section 501 (42 U.S.C. 701) is amended by adding
at the end the following new subsection:
355
‘‘(c)(1)(A) In addition to amounts appropriated
under subsection (a) and retained under section 502(a)(1)
for the purpose of carrying out activities described in sub-
section (a)(2), there is appropriated to the Secretary, out
of any money in the Treasury not otherwise appropriated,
for the purpose of enabling the Secretary (through grants,
contracts, or otherwise) to provide for special projects of
regional and national significance for the development and
support of family-to-family health information centers de-
scribed in paragraph (2), $10,000,000 for each of fiscal
years 2001 through 2006.
‘‘(B) Funds appropriated under subparagraph (A)
shall remain available until expended.
‘‘(2) The family-to-family health information centers
described in this paragraph are centers that—
‘‘(A) assist families of children with disabilities
or special health care needs to make informed
choices about health care in order to promote good
treatment decisions, cost-effectiveness, and improved
health outcomes for such children;
‘‘(B) provide information regarding the health
care needs of, and resources available for, children
with disabilities or special health care needs;
‘‘(C) identify successful health delivery models
for such children;
356
‘‘(D) develop with representatives of health care
providers, managed care organizations, health care
purchasers, and appropriate State agencies a model
for collaboration between families of such children
and health professionals;
‘‘(E) provide training and guidance regarding
caring for such children;
‘‘(F) conduct outreach activities to the families
of such children, health professionals, schools, and
other appropriate entities and individuals; and
‘‘(G) are staffed by families of children with
disabilities or special health care needs who have ex-
pertise in Federal and State public and private
health care systems and health professionals.
‘‘(3) The provisions of this title that are applicable
to the funds made available to the Secretary under section
502(a)(1) apply in the same manner to funds made avail-
able to the Secretary under paragraph (1).’’.
SEC. 956. RESTORATION OF MEDICAID ELIGIBILITY FOR
CERTAIN SSI BENEFICIARIES.
(a) IN GENERAL.—Section 1902(a)(10)(A)(i)(II) (42
U.S.C. 1396a(a)(10)(A)(i)(II)) is amended—
(1) by inserting ‘‘(aa)’’ after ‘‘(II)’’;
(2) by striking ‘‘or who are’’ and inserting
‘‘(bb) who are’’; and
357
(3) by inserting before the comma at the end
the following: ‘‘, or (cc) who are under 21 years of
age and with respect to whom supplemental security
income benefits would be paid under title XVI but
for section 1611(c)(7)’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply to medical assistance for items and
services furnished on or after January 1, 2002, except
that a State may elect to apply such amendments to items
and services furnished on or after any date after the date
of the enactment of this Act and before October 1, 2000.
Æ