S 622 RFH

May 10, 2004

Referred to the Committee on Energy and Commerce

To amend title XIX of the Social Security Act to provide families of disabled children with the opportunity to purchase coverage under the medicaid program for such children, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; TABLE OF CONTENTS.

(a) SHORT TITLE- This Act may be cited as the `Family Opportunity Act of 2004' or the `Dylan Lee James Act'.

(b) AMENDMENTS TO SOCIAL SECURITY ACT- Except as otherwise specifically provided, whenever in this Act an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act.

(c) TABLE OF CONTENTS- The table of contents of this Act is as follows:

Sec. 1. Short title; amendments to Social Security Act; table of contents.

Sec. 2. Opportunity for families of disabled children to purchase medicaid coverage for such children.

Sec. 3. Treatment of inpatient psychiatric hospital services for individuals under age 21 in home or community-based services waivers.

Sec. 4. Development and support of family-to-family health information centers.

Sec. 5. Restoration of medicaid eligibility for certain SSI beneficiaries.

SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO PURCHASE MEDICAID COVERAGE FOR SUCH CHILDREN.

(a) STATE OPTION TO ALLOW FAMILIES OF DISABLED CHILDREN TO PURCHASE MEDICAID COVERAGE FOR SUCH CHILDREN-

(1) IN GENERAL- Section 1902 (42 U.S.C. 1396a) is amended--

(A) in subsection (a)(10)(A)(ii)--

(i) by striking `or' at the end of subclause (XVII);

(ii) by adding `or' at the end of subclause (XVIII); and

(iii) by adding at the end the following new subclause:

`(XIX) who are disabled children described in subsection (cc)(1);'; and

(B) by adding at the end the following new subsection:

`(cc)(1) Individuals described in this paragraph are individuals--

`(A) who have not attained 18 years of age;

`(B) who would be considered disabled under section 1614(a)(3)(C) but for having earnings or deemed income or resources (as determined under title XVI for children) that exceed the requirements for receipt of supplemental security income benefits; and

`(C) whose family income does not exceed such income level as the State establishes and does not exceed--

`(i) 250 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved; or

`(ii) such higher percent of such poverty line as a State may establish, except that--

`(I) any medical assistance provided to an individual whose family income exceeds 250 percent of such poverty line may only be provided with State funds; and

`(II) no Federal financial participation shall be provided under section 1903(a) for any medical assistance provided to such an individual.'.

(2) INTERACTION WITH EMPLOYER-SPONSORED FAMILY COVERAGE- Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by paragraph (1)(B), is amended by adding at the end the following new paragraph:

`(2)(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 shall--

`(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)(XIX) if the parent is determined eligible for such coverage and the employer contributes at least 50 percent of the total cost of annual premiums 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 in an amount that reasonably reflects the premium contribution 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, a State, subject to paragraph (1)(C)(ii), may provide for payment of any portion of the annual premium for such family coverage that the parent is required to pay. Any payments made by the State under this subparagraph 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) 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 subsection:

`(h)(1) With respect to disabled children provided medical assistance under section 1902(a)(10)(A)(ii)(XIX), 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 paragraph (1) may only apply to the extent that--

`(A) in the case of a disabled child described in that paragraph whose family income does not exceed 250 percent of the poverty line, the aggregate amount of such premium and any premium that the parent is required to pay for family coverage under section 1902(cc)(2)(A)(i) does not exceed 7.5 percent of the family's income; and

`(B) the requirement is imposed consistent with section 1902(cc)(2)(A)(ii)(I).

`(3) A State shall not require prepayment of a premium imposed pursuant to paragraph (1) and shall not terminate eligibility of a child under section 1902(a)(10)(A)(ii)(XIX) 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 preceding subparagraph (A), by inserting `1902(a)(10)(A)(ii)(XIX),' after `1902(a)(10)(A)(ii)(XVIII),'.

(d) RULE OF CONSTRUCTION- Notwithstanding any other provision of law, nothing in the amendments made by this section shall be construed as permitting the application of the enhanced FMAP (as defined in section 2105(b) of the Social Security Act (42 U.S.C. 1397ee(b)) to expenditures that are attributable to disabled children provided medical assistance under section 1902(a)(10)(A)(ii)(XIX) of such Act (42 U.S.C. 1396a(a)(10)(A)(ii)(XIX)) (as added by subsection (a) of this section).

(e) EFFECTIVE DATE- The amendments made by this section shall apply to medical assistance for items and services furnished on or after October 1, 2006.

SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL 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 would require inpatient psychiatric hospital services for individuals under age 21,' after `intermediate care facility for the mentally retarded'; and

(B) in the second sentence, by inserting `, or would require inpatient psychiatric hospital services for individuals under age 21' before the period;

(2) in paragraph (2)(B), by striking `or services in an intermediate care facility for the mentally retarded' each place it appears and inserting `services in an intermediate care facility for the mentally retarded, or inpatient psychiatric hospital services for individuals under age 21';

(3) in paragraph (2)(C)--

(A) by inserting `, or who are determined to be likely to require inpatient psychiatric hospital services for individuals under age 21,' after `, or intermediate care facility for the mentally retarded'; and

(B) by striking `or services in an intermediate care facility for the mentally retarded' and inserting `services in an intermediate care facility for the mentally retarded, or inpatient psychiatric hospital services for individuals under age 21'; and

(4) in paragraph (7)(A)--

(A) by inserting `or would require inpatient psychiatric hospital services for individuals under age 21,' after `intermediate care facility for the mentally retarded,'; and

(B) by inserting `or who would require inpatient psychiatric hospital services for individuals 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, 2006.

SEC. 4. 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:

`(c)(1)(A) 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 described in paragraph (2)--

`(i) there is appropriated to the Secretary, out of any money in the Treasury not otherwise appropriated--

`(I) $3,000,000 for fiscal year 2006;

`(II) $4,000,000 for fiscal year 2007; and

`(III) $5,000,000 for fiscal year 2008; and

`(ii) there is authorized to be appropriated to the Secretary, $5,000,000 for each of fiscal years 2009 and 2010.

`(B) Funds appropriated or authorized to be appropriated under subparagraph (A) shall--

`(i) be in addition to amounts appropriated under subsection (a) and retained under section 502(a)(1) for the purpose of carrying out activities described in subsection (a)(2); and

`(ii) 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;

`(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 expertise in Federal and State public and private health care systems and health professionals.

`(3) The Secretary shall develop family-to-family health information centers described in paragraph (2) in accordance with the following:

`(A) With respect to fiscal year 2006, such centers shall be developed in not less than 25 States.

`(B) With respect to fiscal year 2007, such centers shall be developed in not less than 40 States.

`(C) With respect to fiscal year 2008, such centers shall be developed in all States.

`(4) 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 available to the Secretary under paragraph (1)(A).

`(5) For purposes of this subsection, the term `State' means each of the 50 States and the District of Columbia.'.

SEC. 5. 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 `) and' and inserting `and';

(3) by striking `section or who are' and inserting `section), (bb) who are'; and

(4) 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 if subparagraphs (A) and (B) of section 1611(c)(7) were applied without regard to the phrase `the first day of the month following'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to medical assistance for items and services furnished on or after January 1, 2006.

Passed the Senate May 6, 2004.

Attest:

EMILY J. REYNOLDS,

Secretary.

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