Family Opportunity Act of 2005 or Dylan Lee James Act - Amends title XIX (Medicaid) of the Social Security Act (SSA) to give States the option of allowing families of disabled children to purchase Medicaid coverage for such children.
Authorizes the Secretary of Health and Human Services to conduct demonstration projects under which up to ten States are awarded grants, on a competitive basis, to test the effectiveness in improving or maintaining a child's functional level and cost-effectiveness of providing coverage of home and community-based alternatives to psychiatric resident treatment for children enrolled in the Medicaid program.
Amends SSA title V (Maternal and Child Health Services) to make appropriations to the Secretary for special projects of regional and national significance for development and support of family-to-family health information centers.
Amends SSA title XIX to provide for the restoration of Medicaid eligibility to certain SSI (Supplemental Security Income) (SSA title XVI) beneficiaries under age 21.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 183 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 183
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 SENATE OF THE UNITED STATES
January 26, 2005
Mr. Grassley (for himself and Mr. Kennedy) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
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.
This Act may be cited as the ``Family Opportunity Act of 2005''or
the ``Dylan Lee James Act''.
SEC. 2. REFERENCES; TABLE OF CONTENTS.
(a) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this title 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.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title.
Sec. 2. References; table of contents.
Sec. 3. Opportunity for families of disabled children to purchase
medicaid coverage for such children.
Sec. 4. Demonstration projects regarding home and community-based
alternative to psychiatric residential
treatment facilities for children.
Sec. 5. Development and support of family-to-family health information
centers.
Sec. 6. Restoration of medicaid eligibility for certain SSI
beneficiaries.
SEC. 3. 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 are children who have not attained 19 years of
age and are born--
``(i) on or after October 1, 1999 (or, at the
option of a State, on or after an earlier date), in the
case of fiscal year 2006;
``(ii) on or after October 1, 1994 (or, at the
option of a State, on or after an earlier date), in the
case of fiscal year 2007; and
``(iii) after October 1, 1988, in the case of
fiscal year 2008 and any fiscal year thereafter;
``(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) 300 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 300
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)(A)(iii)(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--
``(i) does not exceed 200 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) and other cost
sharing charges do not exceed 5 percent of the family's
income; and
``(ii) exceeds 200, but does not exceed 300,
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) and other cost sharing charges do 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 at least 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.--(1) 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),''.
(2) Section 1905(u)(2)(B) (42 U.S.C. 1396d(u)(2)(B)) is amended by
adding at the end the following sentence: ``Such term excludes any
child eligible for medical assistance only by reason of section
1902(a)(10)(A)(ii)(XIX).''.
(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. 4. DEMONSTRATION PROJECTS REGARDING HOME AND COMMUNITY-BASED
ALTERNATIVE TO PSYCHIATRIC RESIDENTIAL TREATMENT
FACILITIES FOR CHILDREN.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') is authorized to
conduct, during each of fiscal years 2006 through 2010, demonstration
projects (each in the section referred to as a ``demonstration
project'') in accordance with this section under which up to 10 States
(as defined for purposes of title XIX of the Social Security Act) are
awarded grants, on a competitive basis, to test the effectiveness in
improving or maintaining a child's functional level and cost-
effectiveness of providing coverage of home and community-based
alternatives to psychiatric residential treatment for children enrolled
in the medicaid program under title XIX of such Act.
(b) Application of Terms and Conditions.--
(1) In general.--Subject to the provisions of this section,
for the purposes of the demonstration projects, and only with
respect to children enrolled under such demonstration projects,
a psychiatric residential treatment facility (as defined in
section 483.352 of title 42 of the Code of Federal Regulations)
shall be deemed to be a facility specified in section 1915(c)
of the Social Security Act (42 U.S.C. 1396n(c)), and to be
included in each reference in such section 1915(c) to
hospitals, nursing facilities, and intermediate care facilities
for the mentally retarded.
(2) State option to assure continuity of medicaid
coverage.--Upon the termination of a demonstration project
under this section, the State that conducted the project may
elect, only with respect to a child who is enrolled in such
project on the termination date, to continue to provide medical
assistance for coverage of home and community-based
alternatives to psychiatric residential treatment for the child
in accordance with section 1915(c) of the Social Security Act
(42 U.S.C. 1396n(c)), as modified through the application of
paragraph (1). Expenditures incurred for providing such medical
assistance shall be treated as a home and community-based
waiver program under section 1915(c) of the Social Security Act
(42 U.S.C. 1396n(c)) for purposes of payment under section 1903
of such Act (42 U.S.C. 1396b).
(c) Terms of Demonstration Projects.--
(1) In general.--Except as otherwise provided in this
section, a demonstration project shall be subject to the same
terms and conditions as apply to a waiver under section 1915(c)
of the Social Security Act (42 U.S.C. 1396n(c)), including the
waiver of certain requirements under the first sentence of
paragraph (3) of such section but not applying the second
sentence of such paragraph.
(2) Budget neutrality.--In conducting the demonstration
projects under this section, the Secretary shall ensure that
the aggregate payments made by the Secretary under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) do not exceed
the amount by which the Secretary estimates would have been
paid under that title if the demonstration projects under this
section had not been implemented.
(3) Evaluation.--The application for a demonstration
project shall include an undertaking to provide for such
interim and final evaluations of the demonstration project by
independent third parties, and for such interim and final
reports to the Secretary, as the Secretary may require.
(d) Payments to States; Limitations to Scope and Funding.--
(1) In general.--Subject to paragraph (2), a demonstration
project approved by the Secretary under this section shall be
treated as a home and community-based waiver program under
section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c))
for purposes of payment under section 1903 of such Act (42
U.S.C. 1396b).
(2) Limitation.--In no case may the amount of payments made
by the Secretary under this section for State demonstration
projects for a fiscal year exceed the amount available under
subsection (f)(2)(A) for such fiscal year.
(e) Secretary's Evaluation and Report.--The Secretary shall conduct
an interim and final evaluation of State demonstration projects under
this section and shall report to the President and Congress the
conclusions of such evaluations within 12 months of completing such
evaluations.
(f) Funding.--
(1) In general.--For the purpose of carrying out this
section, there are appropriated, from amounts in the Treasury
not otherwise appropriated, for fiscal years 2006 through 2010
a total of $218,000,000, of which--
(A) the amount specified in paragraph (2) shall be
available for each of fiscal years 2006 through 2010;
and
(B) a total of $1,000,000 shall be available to the
Secretary for the evaluations and report under
subsection (f).
(2) Fiscal year limit.--
(A) In general.--For purposes of paragraph (1), the
amount specified in this paragraph for a fiscal year is
the amount specified in subparagraph (B) for the fiscal
year plus the difference, if any, between the total
amount available under this paragraph for prior fiscal
years and the total amount previously expended under
paragraph (1)(A) for such prior fiscal years.
(B) Fiscal year amounts.--The amount specified in
this subparagraph for--
(i) fiscal year 2006 is $21,000,000;
(ii) fiscal year 2007 is $37,000,000;
(iii) fiscal year 2008 is $49,000,000;
(iv) fiscal year 2009 is $53,000,000; and
(v) fiscal year 2010 is $57,000,000.
SEC. 5. 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, such children;
``(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--
``(i) by such families who have expertise in
Federal and State public and private health care
systems; and
``(ii) by 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. 6. 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.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S592-593)
Read twice and referred to the Committee on Finance.
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