Downloaded on June 12, 1997 from the Library
of Congress Thomas Jefferson Page: (S.525)
http://thomas.loc.gov/
Complete Text of S.525, 'Child Health Insurance and Lower
Deficit Act', the Hatch-Kennedy Bill.
FILE s525.is
S 525 IS
105th CONGRESS
1st Session
To amend the Public Health Service Act to provide access to health care
insurance coverage for children.
IN THE SENATE OF THE UNITED STATES
April 8, 1997
Mr. HATCH (for himself, Mr. KENNEDY, Ms. SNOWE, Mr. KERRY, Mr. JEFFORDS,
Mr. DODD, Mr. STEVENS, Mr. ROCKEFELLER, Mr. BENNETT, Mr. DASCHLE, Mr. COLLINS,
Mr. WELLSTONE, Mr. SMITH of Oregon, Mr. BINGAMAN, Mr. CAMPBELL, Mrs. MURRAY,
Mr. REED, Mrs. BOXER, Mr. LAUTENBERG, Mr. DURBIN, and Mr. REID) introduced
the following bill; which was read twice and referred to the Committee
on Labor and Human Resources
A BILL
To amend the Public Health Service Act to provide access to health care
insurance coverage for children. [Italic->] Be it enacted by the Senate
and House of Representatives of the United States of America in Congress
assembled, [<-Italic]
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Child Health Insurance and
Lower Deficit Act'.
(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Purposes.
Sec. 3. Amendment to Public Health Service Act.
`TITLE XXVIII--CHILDREN'S HEALTH INSURANCE GRANT PROGRAM
`PART A--STATE PROGRAMS
`PART B--ASSISTANCE
`SUBPART 1--ASSISTANCE TO FAMILIES
`SUBPART 2--SERVICES FOR PREGNANT WOMEN, NEW MOTHERS, AND INFANTS
`PART C--DEFINITIONS AND MISCELLANEOUS PROVISIONS
`SUBPART 1--DEFINITIONS
`SUBPART 2--MISCELLANEOUS PROVISIONS
Sec. 4. Conforming amendments.
Sec. 5. Effective date.
SEC. 2. PURPOSES. It is the purpose of this Act to benefit American families
by--
(1) providing grants to States to develop and implement a voluntary program
to help purchase health coverage for uninsured, needy children; and
(2) acquiring resources targeted to help reduce the Federal budget deficit
that, if unchecked, will require American families to devote an increasing
proportion of their tax liability to service the debt.
SEC. 3. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding
at the end the following:
`TITLE XXVIII--CHILDREN'S HEALTH INSURANCE GRANT PROGRAM
`PART A--VOLUNTARY STATE GRANT PROGRAMS
`SEC. 2801. AUTHORITY TO ESTABLISH.
`(a) STATE ELECTION- Each State may elect to establish a children's health
insurance program that complies with this title.
`(b) STATE PLAN-
`(1) IN GENERAL- To apply to participate under this part, a State shall,
not later than 90 days prior to the beginning of the calendar year in which
the State program is to begin, prepare and submit to the Secretary a State
plan for the operation of the program.
`(2) APPROVAL BY SECRETARY- The State plan submitted by a State under paragraph
(1) must be approved by the Secretary in order for the State to be eligible
to receive a grant under this title.
`(c) USE OF FUNDS- Under a program under this title, a participating State
shall provide subsidies, consistent with section 2822, for coverage under
a qualifying children's policy and a qualifying children's direct service
benefit option.
`SEC. 2802. REQUIREMENTS FOR QUALIFYING CHILDREN'S POLICY.
`(a) IN GENERAL- Each participating State--
`(1) shall contract with health insurance issuers to make qualifying children's
policies available to subsidy eligible children in the State;
`(2) shall ensure that qualifying children's policies are available to
all eligible children in the State and that each eligible child has the
opportunity to enroll for coverage under such policies;
`(3) shall ensure that a qualifying children's policy provides coverage
for the care described in subsections (b) and (c);
`(4) shall provide for the payment of premium and cost sharing subsidies
(in amounts as defined by the State in accordance with section 2822), that
may include vouchers, to or on behalf of subsidy eligible children, except
that a State electing to participate may not--
`(A) provide a premium subsidy that is less than 95 percent for a subsidy
eligible child in a family with a family income below 185 percent of the
poverty line for a family of the size involved;
`(B) allow the imposition of cost-sharing requirements for preventive services
provided to a subsidy eligible child; or
`(C) enter into a contract with a health insurance issuer offering a qualifying
children's policy that requires that a subsidy eligible child (in a family
with a family income below 150 percent of the poverty line for a family
of the size involved) pay more than 20 percent of the cost-sharing otherwise
applied under such contract as applied with respect to a particular item
or service unless the cost-sharing required under the contract involved
has been deemed by the Secretary as not being a barrier to care for children
of families below 150 percent of poverty line for a family of the size
involved.
`(b) COVERAGE FOR MEDICAL CARE- For purposes of this title, a qualifying
children's policy is a policy for an eligible child that provides coverage
for medical care for such child that is the equivalent of the medical assistance
available (other than cost sharing) to children under the State plan under
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
`(c) ACCESS TO SPECIALITY CARE FOR SPECIAL NEEDS CHILDREN- Each participating
State shall assure that each qualifying children's policy ensure access
to pediatric primary and speciality care providers, including centers of
pediatric specialized treatment expertise.
`(d) ACCESS-
`(1) ACCESS TO POLICIES- In carrying out subsection (a)(1), a participating
State shall, subject to the funding limitation described in section 2822(d),
ensure that subsidy eligible children have access to a qualifying children's
policy provided by a health insurance issuer serving the area in which
the eligible child resides. Such policies may be offered to eligible children
residing in the State through existing public and private purchasing sponsors.
`(2) TO TRADITIONAL PROVIDERS- A participating State shall ensure that
a qualifying children's policy provides access to traditional providers
who have experience in serving populations covered under this title and
in areas in which such populations reside.
`SEC. 2803 REQUIREMENTS FOR QUALIFYING CHILDREN'S DIRECT SERVICE BENEFIT
OPTION.
`(a) IN GENERAL- Each participating State--
`(1) for each area of the State served by a health center (as defined in
section 330), shall contract directly with the health center to provide
services under the program under this title for subsidy eligible children
who choose to receive services from the health center;
`(2) shall ensure that under a qualifying children's direct service benefit
option, coverage is provided for the care described in subsections (c)
and (d);
`(3) shall ensure that services described in subsection (c) which are not
made available by a health center are provided either--
`(A) through contracts for direct payment to specific networks of providers;
or
`(B) through the purchase of wraparound insurance; and
`(4) shall provide for payments in accordance with subsection (b).
`(b) PAYMENTS-
`(1) IN GENERAL- Under a qualifying children's direct service benefit option,
a State may not--
`(A) require that a subsidy eligible child in a family with a family income
below 185 percent of the poverty line for a family of the size involved
pay more than 5 percent of the capitated payment rate;
`(B) allow the imposition of cost-sharing requirements for preventive services
provided to a subsidy eligible child;
`(C) enter into a contract that requires that a subsidy eligible child
(in a family with a family income below 150 percent of the poverty line
for a family of the size involved) pay more than 20 percent of the cost-sharing
otherwise applied by the health center, unless the cost-sharing required
under the contract involved has been deemed by the Secretary as not being
a barrier to care for children of families below 150 percent of the poverty
line for a family of the size involved.
`(c) COVERAGE FOR MEDICAL CARE- For purposes of this title, a qualifying
children's direct service benefit option is an option for a eligible child
that provides coverage for medical care for such child that is the equivalent
of the medical assistance available (other than cost sharing) to children
under the State plan under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.).
`(d) ACCESS TO SPECIALITY CARE FOR SPECIAL NEEDS CHILDREN- Each qualified
children's direct service benefit option shall assure access to pediatric
primary and speciality care providers, including centers of pediatric specialized
treatment expertise. `SEC. 2804. OTHER REQUIREMENTS.
`(a) IN GENERAL- A participating State shall--
`(1) take steps to ensure that information about the availability of the
program, requirements for family participation in the program, benefits
offered, and the application process are disseminated effectively to potential
participants;
`(2) have in effect an outreach system under which families eligible for
assistance under this title are assisted in enrolling in the State program
and are enrolled at a wide variety of locations, including through of traditional
providers of care;
`(3) ensure that every subsidy eligible children have the opportunity to
apply for assistance under the State program under this title pursuant
to State law;
`(4) if the State determines that a child is eligible for cost-sharing
assistance under this title, notify the health plan in which such child
is participating in a timely manner of such eligibility;
`(5) provide to any subsidy eligible child whose claim for assistance under
the State program is denied or is not acted on within a reasonable period
of time, an opportunity under State law for an administrative hearing on
such denial or inaction before the State agency;
`(6) provide to the public, a general description of the rules (including
the objective criteria used) established by the State for making decisions
concerning eligibility for assistance under the State program; and
`(7) use funds received under this title only in accordance with the provisions
of this title.
`(b) DESIGNATION OF STATE AGENCY- A participating State may designate an
appropriate State agency to administer the State program under this title.
`PART B--ASSISTANCE
`SUBPART 1--ASSISTANCE TO FAMILIES
`SEC. 2821. ELIGIBILITY DETERMINATIONS.
`(a) IN GENERAL- The following requirements shall apply with respect to
eligibility determinations for assistance under this title:
`(1) APPLICATIONS- A State program shall provide that an individual may
file an application for assistance in any manner determined appropriate
by the State. Such applications shall--
`(A) be in an understandable form and generally accessible to individuals;
`(B) require the provision of information necessary to make a determination
as to whether a child is eligible for assistance; and
`(C) require attachment of such documentation as deemed necessary by the
Secretary in order to verify eligibility for assistance.
`(2) TERM- The State program may provide for a determination of eligibility
under this section to be effective for a 6-month period or longer.
`(b) COORDINATION- Eligibility determinations made pursuant to this section
may be coordinated with determinations of eligibility for State-administered
health programs to the extent that such coordination brings about administrative
efficiencies.
`SEC. 2822. ASSISTANCE TO FAMILIES.
`(a) STATE APPLICABLE INCOME CRITERIA- For purposes of this title, the
applicable income criteria used by the State for purposes of determining
whether a child is a subsidy eligible child, shall be based on the income
of the family of the subsidy eligible child expressed as a percentage of
the poverty line for a family of the size involved. In establishing the
applicable eligibility criteria and subsidy level, the State shall give
priority to families in the State with the lowest family incomes, except
that the State shall establish a higher income criterion for families with
a disabled child.
`(b) PAYMENTS-
`(1) IN GENERAL- The amount of the assistance available to a subsidy eligible
child shall be paid directly to--
`(A) in the case of a child enrolled in a qualifying children's policy,
the health insurance issuer offering the qualifying children's policy (unless
such plan is a group health plan in which case such payment may be made
directly to the group health plan or the health insurance issuer offering
health insurance coverage through the group health plan, or to the individual);
or
`(B) in the case of an individual receiving benefits under a qualifying
children's direct service benefit option, to the provider and the health
insurance issuer if applicable with whom the State has contracted under
section 2803.
`(2) INDIVIDUAL RESPONSIBILITY- An individual shall be responsible for
any portion of the premium or cost sharing not subsidized by the State.
`(c) SPECIAL RULE-
`(1) IN GENERAL- If a subsidy eligible child enrolls in a group health
plan, a premium subsidy under this title shall be applied only to the amount
of the employee contribution for coverage for a subsidy eligible child.
`(2) RULE OF CONSTRUCTION- Nothing in this section shall be construed to
require that an employer provide a qualifying children's policy to an eligible
child regardless of whether such child is eligible for a subsidy under
this title.
`(d) LIMITATION- Nothing in this title shall be construed to require that
a State provide assistance to subsidy eligible children under this part
in an amount that exceeds the total amount available to the State under
section 2826 (including State matching funds) for carrying out the program
under this title. If the State determines that such available amount is
not sufficient to provide premium subsidies and other assistance under
this part to all subsidy eligible children in the State, the State may
adjust the applicable eligibility criteria appropriately or adjust the
State program in another manner specified by the Secretary prior to the
program year.
`SEC. 2823. PENALTIES FOR MATERIAL MISREPRESENTATION AND FALSE INFORMATION.
`A participating State shall establish penalties to be applied to any individual
who knowingly and willfully makes a material misrepresentation of information
or provides false information in an application for assistance under this
part, and shall otherwise enforce the provisions of this title as determined
appropriate by the State.
`SEC. 2824. AGGREGATE FEDERAL GRANT PAYMENTS.
`(a) PAYMENT SCHEDULE-
`(1) STATE AMOUNT-
`(A) IN GENERAL- A participating State shall be eligible to receive a grant
in an amount under this title that bears the same relationship to the amount
appropriated for such year under section 2825 (and available after the
reservation under paragraph (7)), as the total number of uninsured eligible
children in the State in a base year as determined appropriate by the Secretary
bears to the total number of uninsured eligible children in all participating
States in such base year.
`(B) STATE ALLOCATION ADJUSTMENTS-
`(i) STUDY- Not later than September 30, 1998, the Secretary shall conduct
a study, and prepare and submit to the appropriate committees of Congress
a report, concerning methodology for providing the State allotment under
subparagraph (A) that takes into account an equitable adjustment to the
formula based on variations in costs among States.
`(ii) IMPLEMENTATION OF METHODOLOGY- If determined appropriate and feasible
by the Secretary, the Secretary shall, not later than January 1, 1999,
implement by regulation a methodology for the determination of the maximum
amount under subparagraph (A) that takes into account the relative number
of uninsured eligible children in a State in the base year described in
subparagraph (A) and the relative cost of the delivery of services to those
children. `(2) PAYMENT- Subject to paragraph (1), the Secretary shall provide
for payment under a grant to each participating State for each calendar
quarter, beginning with any quarter beginning on or after April 1, 1998,
of an amount equal to--
`(A)(i) 100 percent of the total amount estimated by the Secretary to have
been expended by the State during such prior quarter for premium and cost-sharing
assistance under this title for enrollment in qualifying children's policies
and for coverage under the qualifying children's direct service benefit
option through the programs operated under part A; less
`(ii) the State matching amount as determined under paragraph (3) for such
prior quarter; and `(B) 50 percent of the total amount estimated by the
Secretary to be expended by the State during such prior quarter for the
proper and efficient administration of the program described in this part.
`(3) STATE MATCHING PERCENTAGE-
`(A) IN GENERAL- With respect to the calendar quarter for which the payment
is to be made under this section, the State will be responsible for contributing
an amount equal to 40 percent of the percentage of the amount the State
is responsible for expending for medical assistance under title XIX of
the Social Security Act, based on the State percentage determined under
section 1905(b) of such Act (42 U.S.C. 1396d(b)), for the State for the
calendar quarter involved.
`(B) LIMITATION- In no case shall the State responsibility under subparagraph
(A) for a calendar quarter be less than an amount equal to 10 percent of
the amount determined under paragraph (2)(A)(i) for the State for the calendar
quarter involved.
`(C) TERRITORIES- In the case of Puerto Rico, the Virgin Islands, Guam,
American Samoa, and the Northern Mariana Islands, the State percentage
for purposes of determining the State matching amount under subparagraph
(A) shall be 20 percent.
`(4) AVAILABILITY OF FUNDS- Except as provided in paragraph (5), amounts
provided to a State under this section shall remain available until expended
by the State.
`(5) REDISTRIBUTION- The Secretary shall establish a procedure for the
redistribution of any funds--
`(A) not expended by a State under this title; and
`(B) as determined by the Secretary, after consultation with the governor
of the State, that are unlikely to be used in the future by the State.
`(6) STATE REQUEST FOR REDUCTION IN FUNDS- Nothing in this section shall
be construed to prohibit a State from requesting only a portion of the
amount allotted to the State under this section.
`(7) RESERVATION-
`(A) IN GENERAL- Of the amount appropriated to carry out this Act for a
fiscal year, the Secretary shall reserve .15 percent of such amount for
allocation among the territories described in paragraph (2)(C).
`(B) ALLOCATION- A territory described in paragraph (2)(C) shall be eligible
to receive an amount that bears the same relationship to the amount reserved
for such year under subparagraph (A), as the total number of uninsured
eligible children in the territory in a base year as determined appropriate
by the Secretary bears to the total number of uninsured eligible children
in all participating territories in such base year.
`(b) REDUCTION IN PAYMENTS FOR ADMINISTRATIVE ERRORS-
`(1) IN GENERAL- In the case of administrative errors described in paragraph
(2), matching payments available to a State under subsection (a) shall
be reduced by an amount determined appropriate by the Secretary.
`(2) ADMINISTRATIVE ERRORS DESCRIBED- The administrative errors described
in this paragraph include the following:
`(A) An eligibility error rate for premium assistance to the extent the
applicable error rate exceeds the maximum permissible error rate specified
by the Secretary.
`(B) Misappropriations or other expenditures that the Secretary finds are
attributable to malfeasance or misfeasance.
`(c) AUDITS- The Secretary shall conduct regular audits of the activities
conducted under this part.
`(d) BUDGETARY TREATMENT- Subject to section 2825, this section constitutes
budget authority in advance of appropriations Acts, and represents the
obligation of the Federal Government to provide payments to the States
in accordance with this section.
`(e) NONENTITLEMENT- Nothing in this title shall be construed as providing
an individual with an entitlement to assistance under this title.
`SEC. 2825. AUTHORIZATION OF APPROPRIATIONS AND DEFICIT REDUCTION. `(a)
AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated
to make Federal payments under this title--
`(1) for fiscal year 1998, $3,000,000,000;
`(2) for fiscal year 1999, $3,000,000,000;
`(3) for fiscal year 2000, $4,000,000,000;
`(4) for fiscal year 2001, $5,000,000,000; and
`(5) for fiscal year 2002, $5,000,000,000.
`(b) DEFICIT REDUCTION TARGETS- For purposes of this section, the deficit
reduction target shall be--
`(1) for fiscal year 1998, $3,000,000,000;
`(2) for fiscal year 1999, $3,000,000,000;
`(3) for fiscal year 2000, $2,000,000,000;
`(4) for fiscal year 2001, $1,000,000,000; and
`(5) for fiscal year 2002, $1,000,000,000. Any amount of revenue available
under this subsection shall be deposited into the Treasury and used for
deficit reduction.
`(c) REDUCTION IN AUTHORIZED AMOUNT-
`(1) IN GENERAL- If, with respect to a fiscal year, the total estimated
amount of revenue derived for the financing of the program under this title
is less than the total target amount determined under paragraph (2), then
the amount referred to for the following fiscal year under subsection (a)
shall be reduced by the amount by which the amount of such estimated revenue
is less than the total target amount determined under paragraph (2) for
such fiscal year multiplied by 2/3 .
`(2) TOTAL TARGET AMOUNT- For purposes of paragraph (1), the total target
amount for a fiscal year shall be equal to the sum of--
`(A) the amount authorized to be appropriated for such year under subsection
(a); and
`(B) the deficit reduction target for such fiscal year under subsection
(b).
`(3) REVENUE IN EXCESS OF ESTIMATES- If the estimated amount of revenue
described in paragraph (1) for a fiscal year is greater than the total
target amount under paragraph (2) for such fiscal year, then the amount
authorized for the following fiscal year under subsection (a) shall be
increased in the same manner as the reduction described in paragraph (1).
`SUBPART 2--SERVICES FOR PREGNANT WOMEN, NEW MOTHERS, AND INFANTS
`SEC. 2831. PROGRAM FOR PREGNANT WOMEN AND INFANTS.
`(a) ESTABLISHMENT OF PROGRAM- A participating State may use up to 5 percent
of the amount of the allotment to the State for a fiscal year under section
2825 to establish a program to meet the needs identified by the State in
the statewide needs assessments prepared by the States under section 505(a)(1)(A)
of the Social Security Act (42 U.S.C. 705(a)(1)(A)).
`(b) COORDINATION- A State shall take actions to ensure that the program
established under this section is coordinated with the programs operated
by the State under title V of the Social Security Act (42 U.S.C. 705).
`(c) MAINTENANCE OF EFFORT- With respect to a State that carries out a
program under this section, funds made available under this title for such
program shall be used to supplement and not supplant current State spending
for the needs described in subsection (a).
`PART C--DEFINITIONS AND MISCELLANEOUS PROVISIONS
`SUBPART 1--DEFINITIONS
`SEC. 2841. DEFINITIONS.
`(a) IN GENERAL- In this title:
`(1) ELIGIBLE CHILD- The term `eligible child' means an individual who
is 18 years of age or younger.
`(2) PARTICIPATING STATE- The term `participating State' means any State
that elects to establish a program under part A.
`(3) POVERTY LINE- The term `poverty line' means 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) that is applicable to a family of the size involved.
`(4) QUALIFYING CHILDREN'S POLICY- The term `qualifying children's policy'
means a policy that meets the standards described in section 2802.
`(5) QUALIFYING CHILDREN'S DIRECT SERVICE BENEFIT OPTION- The term `qualifying
children's direct service benefit option' means the provision of direct
medical assistance under the standards described in section 2803.
`(6) STATE- The term `State' means each of the several States, the District
of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and
the Northern Mariana Islands.
`(7) SUBSIDY ELIGIBLE CHILD- The term `subsidy eligible child' means a
child who--
`(A) meets reasonable eligibility criteria established by the State, and
has a family income that falls within the applicable income criteria (as
defined in section 2822), for purposes of providing subsidies under the
State program;
`(B) is an eligible child;
`(C) is a citizen or qualified alien (as defined in section 431(b) of the
Personal Responsibility and Work Opportunity Reconciliation Act of 1996
(8 U.S.C. 1641(b));
`(D) is not eligible for medical assistance under the State plan under
title XIX of the Social Security Act, except that nothing in this title
shall be construed to require that an individual be denied medical assistance
under a State plan under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) in order for that child to be eligible to receive assistance
under the State program under this title; and
`(E) has not been covered under a group health plan (unless such coverage
was terminated as a result of a change in employment status) during the
6-month period ending on the date on which the individual applies for subsidy-eligible
health coverage under this title. For purposes of subparagraph (E), enrollment
in a health plan under a COBRA continuation provision (as defined in section
2791(d)(4)) shall not constitute enrollment in a group health plan.
`(b) DEFINITIONS RELATING TO INCOME- In this title:
`(1) FAMILY INCOME- The term `family income' means, with respect to an
individual who-- `(A) is not a dependent of another individual, the sum
of the modified adjusted gross incomes for the individual, the individual's
spouse, and children who are dependents of the individual; or
`(B) is a dependent of another individual, the sum of the modified adjusted
gross incomes for the other individual, the other individual's spouse,
and children who are dependents of the other individual. The Secretary
may promulgate rules under which spousal income may be disregarded in instances
where a spouse is not part of a family unit.
`(2) DEPENDENT- The term `dependent' has the meaning given such term under
section 152 of the Internal Revenue Code of 1986. For purposes of this
paragraph, a child who is placed in foster care by a State agency shall
not be considered a dependent of another individual.
`(3) MODIFIED ADJUSTED GROSS INCOME- The term `modified adjusted gross
income' means adjusted gross income (as defined in section 62(a) of the
Internal Revenue Code of 1986)--
`(A) determined without regard to sections 135, 162(l), 911, 931, and 933
of such Code, and `(B) increased by--
`(i) the amount of interest received or accrued by the individual during
the taxable year which is exempt from tax, and
`(ii) the amount of the social security benefits (as defined in section
86(d) of such Code) received during the taxable year to the extent not
included in gross income under section 86 of such Code. The determination
under the preceding sentence shall be made without regard to any carryover
or carryback.
`(c) OTHER DEFINITIONS- The term--
`(1) `group health plan' has the meaning given the term in section 2791(a);
`(2) `health insurance coverage' has the meaning given the term in section
2791(b)(1);
`(3) `health insurance issuer' has the meaning given the term in section
2791(b)(2);
`(4) `health maintenance organization' has the meaning given the term in
section 2791(b)(3); and `(5) `network plan' has the meaning given the term
in section 2791(B)(10).
`(d) REFERENCES TO INDIVIDUAL- For purposes of this title, any reference
to an individual shall include a reference to the parent or guardian of
such individual.
`SUBPART 2--MISCELLANEOUS PROVISIONS
`SEC. 2851. OTHER CONTRIBUTIONS TO PREMIUMS.
`(a) GENERAL RULE- Any employer which elects to make employer contributions
on behalf of an individual who is an employee of such employer, or who
is a dependent of such employee, for health insurance coverage shall not
condition, or vary, such contributions with respect to any such individual
by reason of such individual's status as an individual eligible for assistance
under part B.
`(b) ELIMINATION OF CONTRIBUTIONS- An employer shall not be treated as
failing to meet the requirements of subsection (a) if the employer ceases
to make employer contributions for health insurance coverage for all its
employees.
`(c) ENFORCEMENT- The enforcement provisions applicable to group health
insurance coverage under the amendments made by section 101(e)(2) of the
Health Insurance Portability and Accountability Act of 1996 shall apply
with respect to an employer that violates the provisions of this section
in the same manner as such provisions apply to employers under such amendments.
`SEC. 2852. MAINTENANCE OF EFFORT.
`(a) MEDICAID- A State that elects to participate under this title may
not modify the eligibility requirements for children under the State program
under title XIX of the Social Security Act, as in effect on January 1,
1997 (except that such requirements may be modified pursuant to an application
for a waiver under section 1115 of the Social Security Act (42 U.S.C. 1315)
submitted prior to January 1, 1997), in any manner that would have the
effect of reducing the eligibility of children for coverage under such
program.
`(b) MAINTENANCE OF EFFORT- Funds appropriated pursuant to the authority
of this Act shall be used to supplement and not supplant other Federal
and State funds expended to provide services for disabled individuals.
`SEC. 2853. APPLICATION OF OTHER REQUIREMENTS AND STATE FLEXIBILITY- `(a)
APPLICATION OF INSURANCE REQUIREMENTS UNDER TITLE XXVII- For purposes of
applying sections 2701 (a) through (e) and (g) (relating to limitations
on preexisting conditions and increased portability) except those provisions
relating to late enrollees, waiting periods, and election of alternative
methods under section 2701(c)(3)(B), 2702(a)(1) and (b) (relating to eligibility
to enroll), 2711(a)(1)(A) (relating to guaranteed availability for eligible
individuals), and 2711(c) and (d)(1) (relating to special rules for network
plans and financial capacity) to health insurance issuers offering a qualifying
children's policy and health insurance issuers offering wrap-around insurance
under this title, a qualifying children's policy shall be deemed to be
health insurance coverage offered by a health insurance issuer in the small
group market, in connection with a group health plan, and an eligible individual
shall be considered a small employer for the purposes of section 2711(a)(1)(A),
(c) and (d)(1), except that section 2701(b) shall apply to a qualifying
children's policy offered to a subsidy eligible child.
`(b) STATE FLEXIBILITY- Nothing in this section shall be construed to prevent
a State from establishing or implementing standards or requirements--
`(1) not prescribed in this title; or
`(2) related to the issuance, renewal or portability of health insurance
under a qualifying children's policy or a qualifying children's direct
service benefit option that provide greater protection or benefit to an
eligible child.
`SEC. 2854. REGULATIONS. The Secretary may issue regulations to implement
the program established under this title.
'SEC. 4. CONFORMING AMENDMENTS.
'(a) ERISA- Section 701(c)(1) of the Employee Retirement Income Security
Act of 1974 (as added by section 101(a) of the Health Insurance Portability
and Accountability Act of 1996) is amended by adding at the end the following:
`(K) A qualifying children's policy under the Child Health Insurance and
Lower Deficit Act.
'(b) PUBLIC HEALTH SERVICE ACT- (1) Section 2701(c)(1) of the Public Health
Service Act (as added by section 102(a) of the Health Insurance Portability
and Accountability Act of 1996) is amended by adding at the end the following:
`(K) A qualifying children's policy under the Child Health Insurance and
Lower Deficit Act.
'(2) Section 2761(b)(1)(A) of the Public Health Service Act (as added by
section 102(a) of the Health Insurance Portability and Accountability Act
of 1996) is amended--
'(A) by striking `or church plan' and inserting `church plan'; and
'(B) by inserting before the semicolon the following: `, qualifying children's
policy, or qualifying children's direct service benefit option'.
'SEC. 5. EFFECTIVE DATE. This Act shall become effective on the date of
enactment of this Act, except that funds to carry out programs under the
amendments made by this Act shall not be available prior to January 1,
1998.
Top of Page: - Clinical Freedom
Home Page: - Current Events: - Current
Research:
For Further Information and Feedback:
e-mail: frensasc@ix.netcom.com
John H. Frenster, M.D.
Physicians' Educational Series
247 Stockbridge Avenue
Atherton, CA 94027-5446
Phone: 415/367-6483
FAX: 415/364-1773
clinical freedom: "the ability of the patient and the physician
to do all that is medically necessary without interference."