I
105TH CONGRESS
1ST SESSION
H. R. 560
To amend the Social Security Act to provide for a program of health
insurance for children under 18 years of age and for mothers-to-be.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 4, 1997
Mr. STARK introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Commerce,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To amend the Social Security Act to provide for a program
of health insurance for children under 18 years of age
and for mothers-to-be.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Healthy Start Act of
1997’’.
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SEC. 2. HEALTH INSURANCE FOR CHILDREN AND MOTH-
ERS-TO-BE.
(a) IN GENERAL.—The Social Security Act is amend-
ed by adding at the end the following new title:
‘‘TITLE XXI—HEALTHY START
‘‘SEC. 2100. ESTABLISHMENT OF PROGRAM OF HEALTH IN-
SURANCE FOR CHILDREN AND MOTHERS-TO-
BE.
‘‘There is hereby established a program of health in-
surance for children under 18 years of age and mothers-
to-be.
‘‘PART A—ELIGIBILITY
‘‘SEC. 2101. GENERAL ELIGIBILITY.
‘‘(a) CHILDREN.—
‘‘(1) IN GENERAL.—Every individual—
‘‘(A) who is a child (as defined in para-
graph (2)),
‘‘(B) whose principal place of abode is in
the United States,
‘‘(C) who is a citizen or national of the
United States or a permanent resident alien (as
defined in subsection (d)), and
‘‘(D) who is not covered under a qualified
health plan (as defined in subsection (e)),
is, upon registration under section 2102, entitled to
benefits under this title as a child.
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‘‘(2) CHILD DEFINED.—In this title, the term
‘child’ means an individual from birth until the end
of the month in which the individual attains 18
years of age.
‘‘(b) MOTHERS.—
‘‘(1) IN GENERAL.—Every woman—
‘‘(A) who is a pregnant woman (as defined
in paragraph (2)),
‘‘(B) whose principal place of abode is in
the United States,
‘‘(C) who is a citizen or national of the
United States or a permanent resident alien (as
defined in subsection (d)), and
‘‘(D) who is not covered under a qualified
health plan (as defined in subsection (e)),
is entitled to benefits under this title as a pregnant
woman.
‘‘(2) PREGNANT
WOMAN
DEFINED.—In this
title, the term ‘pregnant woman’ means a woman
during the period—
‘‘(A) beginning on the date she receives the
examination or test which forms the basis for
the certification of pregnancy under section
2102(b)(1), and
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‘‘(B) ending on the last day of the month
in which the 60-day period (beginning on the
date of termination of the pregnancy) ends.
‘‘(c) PREGNANT CHILDREN.—In the case of an indi-
vidual who is entitled under this section to benefits under
this title as a child and as a pregnant woman, the individ-
ual is entitled to benefits as both.
‘‘(d) PERMANENT RESIDENT ALIEN DEFINED.—In
this section, the term ‘permanent resident alien’ means an
alien lawfully admitted for permanent residence or other-
wise permanently residing in the United States under
color of law, and includes an alien granted asylum under
section 208 of the Immigration and Nationality Act or
lawfully admitted as a temporary resident under section
210, 210A, or 245A of such Act.)
‘‘(e) QUALIFIED HEALTH PLAN.—In this section, the
term ‘qualified health plan’ means a plan of health insur-
ance or coverage, an employee welfare benefit plan that
provides health benefits, or other plan (other than under
this title) under Federal or State law that provides cov-
erage of benefits which the Secretary of Health and
Human Services determines is substantially equivalent to
the coverage of benefits provided under this title.
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‘‘SEC. 2102. REGISTRATION; CERTIFICATION OF PREG-
NANCY.
‘‘(a) REGISTRATION OF CHILDREN.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a process for the registration of children at the
time of birth in the United States or at the time of
immigration into the United States or other acquisi-
tion of lawful permanent resident status in the Unit-
ed States.
‘‘(2) TRANSITIONAL REGISTRATION.—The Sec-
retary also shall establish a process for the registra-
tion of children born before the effective date of ben-
efits under this title.
‘‘(3) EFFECT OF FAILURE TO REGISTER.—The
failure of a child to be registered under this sub-
section shall not be considered to deny the child’s
entitlement to benefits under this title, but merely to
delay payment with respect to such benefits under
this title.
‘‘(b) CERTIFICATION OF PREGNANCY AND REGISTRA-
TION OF PREGNANT WOMEN.—
‘‘(1) CERTIFICATION OF PREGNANCY.—A cer-
tification of pregnancy for purposes of this title—
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‘‘(A) may be made by a physician (or such
other qualified health professionals as the Sec-
retary may designate) on the basis of such tests
or procedures as the Secretary may specify,
‘‘(B) shall be stated on such form as the
Secretary shall specify, and
‘‘(C) shall be filed with the Secretary in a
manner specified by the Secretary.
‘‘(2) REGISTRATION.—The Secretary shall es-
tablish a process for the registration of pregnant
women in connection with the filing of a certification
of pregnancy under paragraph (1)(C).
‘‘SEC. 2103. COVERAGE PERIOD.
‘‘(a) IN GENERAL.—No payments may be made
under this part with respect to the expenses of an individ-
ual unless such expenses were incurred by such individual
during a period which, with respect to the individual, is
a coverage period under this section.
‘‘(b) CHILDREN.—With respect to an individual enti-
tled to benefits under this title as a child, the coverage
period shall begin on the first date (on or after the effec-
tive date of benefits under this title) on which the individ-
ual meets the requirements for such entitlement under
section 2101(a) and shall end on the day before the first
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month in which the individual no longer meets such re-
quirements.
‘‘(c) PREGNANT WOMEN.—With respect to an indi-
vidual entitled to benefits under this title as a pregnant
woman, the coverage period shall begin on the first date
(on or after the effective date of benefits under this title)
on which the individual meets the requirements for such
entitlement under section 2101(b) and shall end on the
day before the first month in which the individual no
longer meets such requirements.
‘‘PART B—BENEFITS
‘‘SEC. 2111. SCOPE OF BENEFITS FOR CHILDREN.
‘‘(a) IN GENERAL.—Except as provided in the suc-
ceeding provisions of this section, the benefits provided to
an individual by the program established by this part shall
consist of the same benefits that are available under title
XVIII to individuals entitled to benefits under part A of
that title and enrolled under part B of that title plus a
benefit for prescription drugs and biologicals necessary to
meet catastrophic costs for such drugs and biologicals, as
determined by the Secretary.
‘‘(b) WELL CHILD SERVICES.—
‘‘(1) IN GENERAL.—In addition to the benefits
described in subsection (a), in the case of an individ-
ual entitled to benefits under this title as a child, the
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benefits under this title shall include entitlement to
have payment made (in the same manner as for phy-
sicians’ services under part B of title XVIII) for the
following, without the application of deductibles, co-
insurance, or copayments, subject to the periodicity
schedule established with respect to the services
under paragraph (2):
‘‘(A) Newborn and well-baby care, includ-
ing normal newborn care and pediatrician serv-
ices for high-risk deliveries.
‘‘(B) Well-child care, including routine of-
fice visits, routine immunizations (including the
vaccine itself), routine laboratory tests, and pre-
ventive dental care.
‘‘(C) Early and periodic screening, diag-
nostic, and treatment services (as defined in
section 1905(r) of the Social Security Act).
‘‘(2) PERIODICITY SCHEDULE.—The Secretary,
in consultation with the American Academy of Pedi-
atrics, shall establish a schedule of periodicity which
reflects the general, appropriate frequency with
which services listed in paragraph (1) should be pro-
vided to healthy children.
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‘‘SEC. 2112. SCOPE OF BENEFITS FOR PREGNANT WOMEN.
‘‘(a) IN GENERAL.—In the case of an individual enti-
tled to benefits under this title as a pregnant woman, the
benefits under this title shall consist of entitlement to have
payment made for the following, without the application
of deductibles, coinsurance, or copayments, subject to the
periodicity schedule established with respect to the serv-
ices under subsection (b):
‘‘(1) Prenatal care, including care for all com-
plications of pregnancy.
‘‘(2) Inpatient labor and delivery services.
‘‘(3) Postnatal care.
‘‘(4) Postnatal family planning services.
‘‘(b) PERIODICITY SCHEDULE.—The Secretary, in
consultation with the American College of Obstetrics and
Gynecology, shall establish a schedule of periodicity which
reflects the general, appropriate frequency with which
services listed in subsection (a) should be provided to preg-
nant women without complications of pregnancy.
‘‘SEC. 2113. EXCLUSIONS.
‘‘(a) IN GENERAL.—Except as provided in sub-
sections (b) and (c), section 1862 shall apply to expenses
incurred for items and services provided under this title
the same manner as such section applies to items and
services provided under title XVIII.
‘‘(b) BENEFITS EXCEPTION.—
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‘‘SEC. 2123. APPLICABLE TITLE XXI PREMIUM.
‘‘For purposes of section 59B of the Internal Revenue
Code of 1986, the Secretary shall, during September of
each year (beginning with 1998), determine a title XXI
applicable premium for months in the succeeding calendar
year. Such premium for months in a year shall be such
amount as the Secretary estimates so that—
‘‘(1) 12 times the product of such amount and
the average number of families with individuals enti-
tled to benefits under section 2101 in any month in
the year, is equal to
‘‘(2) the total of the benefits and administrative
costs which the Secretary estimates will be payable
from the Children Health Insurance Trust Fund for
services performed and related administrative costs
incurred in such year.
In calculating the amount under paragraph (2), the Sec-
retary shall include an appropriate amount for a contin-
gency margin.
‘‘PART D—GENERAL PROVISIONS
‘‘SEC. 2131. INCORPORATION OF CERTAIN MEDICARE PRO-
VISIONS.
‘‘(a) USE OF CARRIERS AND INTERMEDIARIES.—The
Secretary shall provide for the administration of this title
through the use of fiscal intermediaries and carriers in
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the same manner as title XVIII is carried out through
the use of such fiscal intermediaries and carriers.
‘‘(b) DEFINITIONS.—Except as otherwise provided in
this title, the definitions contained in section 1861 shall
apply for purposes of this title in the same manner as they
apply for purposes of title XVIII.
‘‘(c) CERTIFICATION, PROVIDER
QUALIFICATION,
ETC.—The provisions of sections 1863 through 1875, sec-
tions 1878 through 1880, section 1883, section 1885, and
sections 1887 through 1892 shall apply to this title in the
same manner as they apply to title XVIII.
‘‘(d) HEALTH MAINTENANCE ORGANIZATIONS AND
COMPETITIVE MEDICAL PLANS.—
‘‘(1) IN GENERAL.—Except as provided in this
subsection, section 1876 shall apply to individuals
entitled to benefits under this title in the same man-
ner as such section applies to individuals entitled to
benefits under part A, and enrolled under part B, of
title XVIII.
‘‘(2) LIMITATION TO REASONABLE COST REIM-
BURSEMENT CONTRACTS FOR PREGNANT WOMEN.—
‘‘(A) IN GENERAL.—The provisions of sec-
tion 1876 relating only to risk-sharing contracts
(and not to reasonable cost reimbursement con-
tracts) shall not apply to individuals entitled to