(y' ' 0-V3 Library' \ C2-07-i3 j 7S00 Security Eivd. i Boitimors, Mar/^nd 21244 I 106th congress 1646 S. 1st Session To amend titles XEX and XXI of the Social Security Act to improve the coverage of needy children under the State Children's Health Insurance Program (SCHIP) and the Medicaid Program. IN THE SENATE OF THE UNITED STATES September 28, 1999 Mrs. Lincoln (for herself, Ms. Landrieu, Mr. Smith of Oregon, Mr. Bayh, and ^Nlrs. Feinstein) introduced the foUoAving bill; which was read twice and referred to the Committee on Finance A BILL To amend titles XIX and XXI of the Social Security Act to improve the coverage of needy children under the State Children's Health Insurance Program (SCHIP) and the Medicaid Program. 1 Be it enacted hy the Senate and House ofRepresenta- 2 tives ofthe United States ofAmerica in Congress assembled, 3 SECTION 1. SHORT TITLE; REFERENCES IN ACT; TABLE OF 4 CONTENTS. — 5 (a) Short Title. This Act may be cited as the 6 "Improved Maternal and Children's Health Coverage 7 Act". — 2 — 1 (b) References to Sociajj Security Act. Ex- 2 cept as otherwise expressly provided, whenever in this Act 3 an amendment or repeal is expressed in terms of an 4 amendment to, or repeal of, a section or other provision, 5 the reference shaU be considered to be made to a section 6 or other provision of the Social Security Act. — 7 (c) Table of Contents. The table of contents of 8 this Act is as follows: Sec. 1. Short title; references in Act; table ofcontents. Sec. 2. Simplified outreach and enrollment. Sec. 3. Family friendly coverage and enrollment. Sec. 4. Expanded coverage options. 9 SEC. 2. SIMPLIFIED OUTREACH AND ENROLLMENT. 10 (a) Use of Uniform Application and Coordi- — NATED Enrollment Process. 1 1 12 (1) SCHIP PROGRAM.—Section 2102 (42 13 U.S.C. 1397bb) is amended by adding at the end the 14 following new subsection: 15 "(d) Development and Use of Uniform Appli- 16 CATION Forms and Coordinated Enrollment Proc- — 17 ess. ^A State child health plan shall provide, by not later 18 than the first day of the first month that begins more than 19 6 months after the date of the enactment of this sub- 20 section, for 21 "(1) the development and use of a uniform, sim- 22 plified application form which is used both for pur- •S 1646 IS 3 1 poses of establishing eligibility for benefits under 2 this title and also under title XEK; and 3 "(2) an enrollment process that is coordinated 4 with that under title XIX so that a family need only 5 interact with a single agency in order to determine 6 whether a child is eligible for benefits under this 7 title or title XIX.". — 8 (2) Medicaid conforming amendment. 9 (A) In general.—Section 1902(a) (42 10 U.S.C. 1396a(a)) is amended— 11 (i) by striking the period at the end of 12 paragraph (65) and inserting "; and", and 13 (ii) by inserting after paragraph (65) 14 the following new paragraph: 15 "(66) provide, by not later than the first day of 16 the first month that begins more than 6 months 17 after the date of the enactment of this paragraph, 18 in the case of a State with a State child health plan 19 under title XXI for— 20 "(A) the development and use of a uni- 21 form, simplified application form which is used 22 both for purposes of establishing eligibility for 23 benefits under this title and also under title 24 XXL; and •S 1646 IS 4 1 "(B) establishment and operation of an en- 2 roUment process that is coordinated with that 3 under title XXI so that a family need only 4 interact with a single agency in order to deter- 5 mine whether a child is eligible for benefits 6 under this title or title XXI.". — 7 (B) Effective date. The amendments 8 made by subparagi-aph (A) apply to calendar 9 quarters beginning more than 6 months after 10 the date of the enactment of this Act. 11 (b) Financial Incentives To Promote Appro- — 12 PRiATE Enrollment. 13 (1) Expanded availability of funding for 14 administrative costs related to outreach — 15 and eligibility determinations. Section 16 1931(h) (42 U.S.C. 1396u-l(h)) is amended— 17 (A) in the matter preceding paragraph (1), 18 by striking "Transitional" and all that fol- 19 lows through "Costs" and inserting "IN- 20 creased Federal Matching Rate for Ad- 21 ministrative Costs Related to Certain 22 Outreach and Eligibility Determina- 23 TIONS"; 24 (B) in paragi'aph (2), by inserting "either" 25 after "attributable" and by inserting before the •S 1646 IS 5 1 period at the end the following: "or to adminis- 2 trative costs of determinations of the eligibility 3 of children and pregnant women for benefits 4 under the State plan under this title or title 5 XXI, outreach to children and pregnant women 6 likely to be eligible for such benefits, and such 7 other outreach- and eligibility-related activities 8 as the Secretary may approve"; 9 (C) in paragraph (3), by striking "and 10 ending with fiscal year 2000"; and 11 (D) by striking paragraph (4) and insert- 12 ing the following: 13 "(4) Encouraging use of local and com- 14 munity-based organizations in outreach and — 15 ENROLLMENT ACTIVITIES. The Secretary shall es- 16 tablish a procedure under which, if States do not 17 otherwise obligate the amounts made available under 18 this subsection, local and community-based public or 19 nonprofit organizations (including local and county 20 governments, public health departments, community 21 health centers, children's hospitals, and dispropor- 22 tionate share hospitals) may seek to have adminis- 23 trative costs relating to outreach and enrollment of 24 children and pregnant women under this title and XXI 25 title be treated as administrative costs of a •S 1646 IS — 6 1 State described in section 1903(a)(7), if such orga- 2 nizations have the permission of the State involved. 3 A State may require such an organization to provide 4 payment of such amounts as the State would other- 5 wise be responsible for in order to obtain payment 6 under this paragraph.". 7 (2) Use of 3 percent of schip funds at 90 8 percent federal match for enrollment and — 9 OUTREACH ACTIVITIES. Section 2105(b) (42 10 U.S.C. 1397ee(b)) is amended— 1 1 (A) by designating the matter following the 12 dash as a paragraph (1) with appropriate in- 13 dentation and vnth the heading "(1) In GEN- 14 eral"; " - 15 (B) by inserting "subject to paragraph 16 (2)," after "(a),"; 17 (C) by striking "(1)" and "(2)" and in- 18 serting "(A)" and "(B)", respectively; and 19 (D) by adding at the end the following 20 paragraph: 21 "(2) Special rule for certain enroll- 22 ment and outreach activities. — 23 "(A) In GENERAL. For purposes of sub- 24 section (a), in the case of a State that meets 25 the requirement of subparagraph (B), and sub- •S 1646 IS 7 \ 1 ject to subparagraph (C), the 'enhanced FMAP' 2 is equal to 90 percent with respect to amounts 3 expended on enrollment and outreach activities. — 4 "(B) Requirements. Subparagraph (A) 5 shall only apply to a State if the State meets 6 the following requirements: — 7 "(i) No ASSET TEST. The State does . 8 not impose an asset test for eligibility 9 under the State child health plan or under 10 section 1902(1) with respect to children. Compliance with 11 "(ii) - — 12 OUTSTATIONING REQUIREMENT. The SeC- 13 retary finds that the State is providing for 14 the receipt and initial processing of apph- 15 cations of certain individuals at facilities 16 defined as disproportionate share hospitals 17 under section 1923(a)(1)(A) and Feder- 18 ally-qualified health centers described in 19 section 1905(1)(2)(B) consistent with the 20 requirements of section 1902(a)(55). 21 "(iii) Compliance with simplified •: 22 OUTREACH AND ENROLLMENT PROVI- — 23 SIGNS. The Secretary finds that the State 24 is providing for outreach and enrollment 25 under this title and title XIX consistent >S 1646 IS 8 1 with the requirements of sections 2102(c), 2 2102(d), and 1902(a)(66). 3 "(C) Limitation to 3 percent of an- — 4 NUAL ALLOTMENT. Subparagraph (A) shall 5 not apply to amounts expended by a State in a 6 fiscal year in excess of 3 percent of the amount 7 of the amount of its allotment under section 8 2104 for that fiscal year.". — 9 (3) Effective date. The amendments made 10 by this subsection take effect on the date of the en- 11 actment of this Act and apply to expenditures made 12 on or after the date of the enactment of this Act. 13 (c) Additional Entities Qualified To Deter- 14 mine Medicaid Presumptive EliCxIbility for Low-In- 15 come Children.—Section 1920A(b)(3)(A)(i) (42 U.S.C. amended— 16 1396r-la(b)(3)(A)(i)) is 17 (1) by striking "or (II)" and inserting ", (II)"; 18 and 19 (2) by inserting "eligibility of a child for med- 20 ical assistance under the State plan under this title, 21 or eligibility of a child for child health assistance 22 under the program funded under title XXI, (III) is 23 an elementary^ school or secondary school, as such 24 terms are defined in section 14101 of the Elemen- 25 tary and Secondary Education Act of 1965 (20 •S 1646 IS — 9 1 U.S.C. 8801), an elementary or secondary school op- 2 erated or supported by the Bureau of Indian Affairs, 3 a State child support enforcement agency, a child 4 care resource and referral agency, or a State office 5 or private contractor that accepts applications for or A 6 administers a program funded under part of title 7 rV or that determines eligibility for any assistance 8 or benefits provided under any program of public or 9 assisted housing that receives Federal funds, includ- 10 ing the program under section 8 or any other section 11 of the United States Housing Act of 1937 (42 12 U.S.C. 1437 et seq.), or (IV) any other entity the 13 State so deems" before the semicolon. 14 SEC. 3. FAMILY FRIENDLY COVERAGE AND ENROLLMENT. 15 (a) Assuring Coordination of Pediatric Pro- — 16 viDERS Within A Family. 17 (1) In general.—Section 2103 (42 U.S.C. 18 1397cc) is amended by adding at the end the fol- 19 lowing new subsection: 20 "(g) Steps Taken To Coordinate Provision of — 21 Pediatric Care Within a Family. To the extent a 22 State child health plan provides coverage other than 23 through providing benefits under the State's medicaid 24 plan under title XTK, the State child health plan S 1646 IS-- 2 10 1 "(1) shall specify methods being used to ensure 2 that children within a family who are eligible for as- 3 sistance under the plan are allowed to be seen by the 4 same pediatric provider or group of pediatric pro- 5 viders in a manner that permits the coordinated re- 6 ceipt of care by children in the same family; and 7 "(2) shall include a description of such methods 8 in each annual report submitted under section 9 2108(a).". — 10 (2) Effective date. The amendment made 11 by paragraph (1) apphes on the date of the enact- 12 ment of this Act and to reports submitted for years 13 beginning- with 2000. 14 (b) Reduction in Burden of Administering — 15 Cost-Sharing Provisions. 16 (1) State responsible for assuring cap — 17 ON COST-SHARING NOT EXCEEDED. Section 18 2103(e)(3) (42 U.S.C. 1397cc(e)(3)) is amended by 19 adding at the end the following new subparagraph: 20 "(C) State and contractors respon- 21 SIBLE FOR APPLYING LIMITATIONS ON COST- — 22 SHARING. The State child health plan shall 23 provide that responsibility for assuring comph- 24 ance with the Hmitations on cost-sharing under 25 this paragraph falls on the State and on its •S 1646 IS