P.Uo Uws fW t'MslK&4 kn^/ls+SW^ 20(97 : !ICC725M-0S007LS-ie1bcr3uarriytyBlvd. !Baltimore, Marytand 21244 110thCONGRESS H.R.3215 1stSession ToamendtitleXIXoftheSocialSecurityActtoprovidemedicalassistance for certain men screened and found to have prostate cancer under a federallyfundedscreeningprogram. IN THE HOUSE OF REPRESENTATIVES July27,2007 Ms.Nortonintroducedthefollowingbill;whichwasreferredtothe CommitteeonEnergyandCommerce A BILL To amend title XLX of the Social Security Act to provide medical assistance for certain men screened and found to have prostate cancerunder afederallyfunded screen- ingprogram. 1 BeitenactedbytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 3 SECTION1.SHORTTITLE. 4 This Act may be cited as the "Medicaid Prostate 5 CancerCoverageActof2007". — 2 1 SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN 2 PROSTATECANCERPATIENTS. 3 (a) Coverage as Optional Categorically — 4 NeedyGroup. 5 (1) In general.—Section 1902(a)(10)(A)(ii) 6 of the Social Security Act (42 U.S.C. 7 1396a(a)(10)(A)(ii)) isamended— 8 (A) in subclause (XVIII), bystriking"or" 9 attheend; 10 (B) in subclause (XLX),byadding "or" at 11 theend;and 12 (C)byaddingattheendthefollowing: 13 "(XX) who are described in sub- 14 section (dd) (relatingto certain pros- 15 tatecancerpatients);". — 16 (2) Group described. Section 1902 ofsuch 17 Act (42 U.S.C. 1396a) is amendedbyaddingatthe 18 endthefollowing: 19 "(dd) Individualsdescribedinthisparagrapharein- 20 dividualswho 21 "(1) are not described in subsection 22 (a)(10)(A)(i); 23 "(2)havenotattainedage65; 24 "(3) have been screened for prostate cancer 25 undersection 317DofthePublicHealthSendeeAct 26 (42 U.S.C. 247b-5), or any other prostate cancer •HR3215IH — 3 1 screening program supported with Federal funds, 2 andneedtreatmentforprostatecancer; 3 "(4) are in families whose income does not ex- 4 ceed 250 percent ofthe income official poverty line 5 (asdefinedbytheOfficeofManagementandBudg- 6 et, and revised annually in accordance with section 7 673(2) oftheOmnibusBudgetReconciliationActof 8 1981) applicabletoafamilyofthesizeinvolved; and 9 "(5) are nototherwise coveredunder creditable 10 coverage, asdefinedin section2701(c) ofthePublic 11 Health ServiceAct(45U.S.C. 300gg(c)).". — 12 (3) Limitation on benefits. Section 13 1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10)) 14 is amended in the matter following subparagraph 15 (G) 16 (A) bystriking "and (XTV)" andinserting 17 "(XIV)";and 18 (B) by inserting ", and (XV) the medical 19 assistance made available to an individual de- 20 scribed in subsection (aa) who is eligible for 21 medical assistance only because of subpara- 22 graph (A)(10)(ii)(XX) shall be limited to med- 23 ical assistance provided during the period in 24 which such anindividualrequires treatmentfor 25 prostatecancer"beforethesemicolon. •HR3215HI — 4 — 1 (4) Conforming amendments. Section 2 1905(a) of the Social Security Act (42 U.S.C. 3 1396d(a)) isamendedinthematterprecedingpara- 4 graph (1) 5 (A) in clause (xii), bystriking"or" atthe 6 end; 7 (B) in clause (xiii), by adding "or" atthe 8 end;and 9 (C) byinserting after clause (xiii) the fol- 10 lowing: 11 "(xiv) individuals described in section 12 1902(dd),". — 13 (b)PresumptiveEligibility. 14 (1) In general.—Title XLX ofthe Social Se- 15 curityAct (42 U.S.C. 1396 et seq.) is amended by 16 insertingaftersection 1920Bthefollowing: 17 "presumptiveeligibilityforcertainprostate 18 CANCERpatients 19 "Sec. 1920C. (a) StateOption.—AStateplanap- 20 provedunder section 1902 mayprovide formakingmed- 21 icalassistanceavailableto anindividualdescribedinsec- 22 tion 1902(dd) (relating to certain prostate cancer pa- 23 tients)duringapresumptiveeligibilityperiod. — 24 "(b)Definitions. Forpurposesofthissection: — 25 "(1) Presumptive eligibility period. The 26 term 'presumptive eligibilityperiod' means, with re- •HR3215IH — — 5 1 spect to an individual described in subsection (a), 2 theperiodthat 3 "(A) begins with the date on which a 4 qualifiedentitydetermines, onthebasisofpre- 5 liminary information, that the individual is de- 6 scribedinsection 1902(dd);and 7 "(B) ends with (and includes) the earlier 8 of— 9 "(i) thedayonwhich adetermination 10 is made with respect to the eligibility of 11 suchindividualforservicesundertheState 12 plan;or 13 "(ii) inthe case ofsuch an individual 14 whodoesnotfileanapplicationbythelast 15 dayofthemonthfollowingthemonthdur- 16 ingwhich the entitymakes the determina- 17 tion referredto in subparagraph (A), such 18 lastday. — 19 "(2)Qualifiedentity. — 20 "(A) In GENERAL. Subject to subpara- 21 graph (B), the term 'qualified entity' means 22 anyentitythat 23 "(i) is eligible for payments under a 24 Stateplanapprovedunderthistitle;and HR3215III — 6 1 "(ii) is determinedbythe Stateagen- 2 cytobe capable ofmakingdeterminations 3 ofthe type describedin paragraph (1)(A). — 4 "(B) Regulations. The Secretary may 5 issue regulations further limiting those entities 6 that may become qualified entities in order to 7 preventfraud and abuse andforotherreasons. — 8 "(C) Rule of construction. Nothing 9 in this paragraph shall be construed as pre- 10 ventinga Statefrom limitingthe classes ofen- 11 tities that may become qualified entities, con- 12 sistentwithanylimitationsimposedundersub- 13 paragraph(B). — 14 "(c)Administration. — 15 "(1)Ingeneral. TheStateagencyshallpro- 16 videqualifiedentitieswith 17 "(A) such forms as are necessary for an 18 application to be made by an individual de- 19 scribedin subsection (a) formedical assistance 20 undertheStateplan;and 21 "(B) informationonhowto assistsuchin- 22 dividualsincompletingandfilingsuchforms. 23 "(2) Notification requirements.—A quali- 24 fied entity that determines under subsection 25 (b)(1)(A) that an individual described in subsection •HR3215IH — — — 7 1 (a) is presumptively eligible for medical assistance 2 underaStateplanshall 3 "(A) notifythe State agencyofthe deter- 4 ruination "within 5 working days after the date 5 onwhichdeterminationismade; and 6 "(B) inform such individual at the time 7 the determination is made that an application 8 for medical assistance under the State plan is 9 required to be made by not later than the last 10 day of the month following the month during 11 whichthedeterminationismade. 12 "(3) Application for medical assist- — 13 ANCE. In the case of an individual described in 14 subsection (a) whoisdeterminedbyaqualifiedenti- 15 tytobepresumptivelyeligibleformedicalassistance 16 under a State plan, the individual shall apply for 17 medicalassistanceundersuchplanbynotlaterthan 18 the last day ofthe month followingthe month dur- 19 ingwhichthedeterminationismade. — 20 "(d) Payment. Notwithstanding any other provi- 21 sionofthistitle,medicalassistancethat 22 "(1) is furnished to an individual described in 23 subsection(a) 24 "(A) during a presumptive eligibility pe- 25 riod; •HR32151H 8 1 "(B) by an entitythat is eligible for pay- 2 mentsundertheStateplan; and 3 "(2) isincludedinthecareandservicescovered 4 bytheStateplan; 5 shall be treated as medical assistance provided by such 6 planforpurposesofsection1903(a)(5)(B).". — 7 (2) Conformingamendments. 8 (A) Section 1902(a)(47) ofthe Social Se- 9 curityAct (42 U.S.C. 1396a(a)(47)) is amend- 10 ed— 11 (i) by striking "and provide" and in- 12 serting provide";and 13 (ii) by inserting before the semicolon 14 attheendthefollowing: ", andprovidefor 15 making medical assistance available to in- 16 dividualsdescribedinsubsection (a) ofsec- 17 tion 1920C duringapresumptiveeligibility 18 periodinaccordancewithsuchsection". 19 (B) Section 1903(u)(l)(D)(v) of such Act 20 (42U.S.C. 1396b(u)(l)(D)(v))isamended— 21 (i) by striking "or for" and inserting 22 ",for";and 23 (ii) byinsertingbefore the period the 24 following: ", orfor medical assistancepro- 25 vided to an individual described in sub- •HR3215IH 1 section (a) ofsection 1920C duringa pre- 2 sumptive eligibility period under such sec- 3 tion". 4 (c) Enhanced Match.—Section 1903(a)(5) ofthe 5 SocialSecurityAct(42U.S.C. 1396b(a)(5))isamended— 6 (1)bystriking"an"andinserting"(A)an"; 7 (2) by adding "plus" after the semicolon; and 8 (3)byaddingattheendthefollowing: 9 "(B) an amount equal to 75 percent of the 10 sums expended during such quarter which are at- 11 tributable to the offering, arranging, and furnishing 12 (directly or on a contract basis) ofprostate cancer- 13 relatedtreatmentservices;plus". 14 (d) Effective Date.—The amendments made by 15 this section apply to medical assistance furnished on or 16 afterthedateoftheenactmentofthisAct,withoutregard 17 towhetherfinalregulationstocarryoutsuchamendments 18 havebeenpromulgatedbysuchdate. 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