Home > 105th Congressional Bills > H.R. 1812 (ih) To provide for the elimination of the Department of Education, and for other purposes. ...H.R. 1812 (ih) To provide for the elimination of the Department of Education, and for other purposes. ...
108th CONGRESS
1st Session
H. R. 1811
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 11, 2003
Mr. Sessions (for himself, Mr. Waxman, Mr. Abercrombie, Mr. Bachus, Mr.
Bartlett of Maryland, Mr. Brown of Ohio, Mr. Camp, Mrs. Capps, Mrs.
Christensen, Mr. Crowley, Mrs. Jo Ann Davis of Virginia, Ms. DeGette,
Mr. Deutsch, Mr. Dingell, Mr. Doyle, Mr. Engel, Mr. Farr, Mr. Frost,
Mr. Gordon, Mr. Green of Texas, Mr. Hinchey, Mr. Hoeffel, Mr. Inslee,
Mr. Isakson, Mr. Kildee, Ms. Kilpatrick, Mr. Lantos, Mrs. Maloney, Mr.
Markey, Mr. Matsui, Mr. McNulty, Mr. George Miller of California, Mr.
Moore, Mr. Moran of Virginia, Mr. Murtha, Mrs. Northup, Mr. Oxley, Mr.
Pallone, Mr. Paul, Mr. Payne, Mr. Rahall, Ms. Schakowsky, Mr. Schiff,
Mr. Scott of Virginia, Mr. Shays, Ms. Solis, Mr. Souder, Mr. Stark, Mr.
Strickland, Mr. Terry, Mr. Thornberry, Mr. Towns, Mr. Udall of
Colorado, Mr. Wolf, Mrs. Capito, Mrs. Johnson of Connecticut, Mr. John,
Mr. Reynolds, and Mr. Kucinich) introduced the following bill; which
was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
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 2003'' 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 income official poverty
line (as defined by the Office of Management 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
``(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) 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 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 Amendments.--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) Effective Date.--The amendments made by this section shall
apply to medical assistance for items and services furnished on or
after October 1, 2005.
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 January 1,
2004.
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 2004;
``(II) $4,000,000 for fiscal year 2005; and
``(III) $5,000,000 for fiscal year 2006; and
``(ii) there is authorized to be appropriated to the
Secretary, $5,000,000 for each of fiscal years 2007 and 2008.
``(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) under this subsection in
accordance with the following:
``(A) With respect to fiscal year 2004, such centers shall
be developed in not less than 25 States.
``(B) With respect to fiscal year 2005, such centers shall
be developed in not less than 40 States.
``(C) With respect to fiscal year 2006, such centers shall
be developed in not less than 50 States and the District of
Columbia.
``(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)
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