[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1238 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 1238
To amend titles XVIII, XIX, and XXI of the Social Security Act to
improve women's health, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 11, 2003
Mrs. Lincoln (for herself, Mrs. Murray, Ms. Landrieu, and Ms. Cantwell)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XVIII, XIX, and XXI of the Social Security Act to
improve women's health, 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 ``Improving Women's
Health Act of 2003''.
(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.
TITLE I--IMPROVING PREVENTIVE HEALTH BENEFITS UNDER MEDICARE
Sec. 101. Therapy and counseling for cessation of tobacco use.
Sec. 102. Counseling for post-menopausal women.
Sec. 103. Screening for diminished visual acuity.
Sec. 104. Screening for hearing impairment.
Sec. 105. Expansion of eligibility for bone mass measurement.
Sec. 106. coverage of cardiovascular screening tests.
Sec. 107. Coverage of medical nutrition therapy services for
beneficiaries with cardiovascular diseases.
Sec. 108. Medicare coverage of diabetes laboratory diagnostic tests.
Sec. 109. Coverage of annual screening pap smear and pelvic exams.
Sec. 110. Adjustments to local fee schedules for clinical laboratory
tests for improvement in cervical cancer
detection.
Sec. 111. Enhanced reimbursement under the medicare program for
screening and diagnostic mammography
services; not counting certain radiology
residents against graduate medical
education limitations.
Sec. 112. Elimination of deductibles and coinsurance for existing
preventive health benefits.
TITLE II--IMPROVING MEDICARE FOR FAMILY CAREGIVERS BY COVERING ADULT
DAY SERVICES
Sec. 201. Findings.
Sec. 202. Medicare coverage of substitute adult day services.
TITLE III--IMPROVING AND EXPANDING PRENATAL CARE FOR LOW-INCOME WOMEN
Sec. 301. State option to expand or add coverage of certain pregnant
women under medicaid and schip.
Sec. 302. Optional coverage of legal immigrants under the medicaid
program and SCHIP.
Sec. 303. Promoting cessation of tobacco use under the medicaid
program.
Sec. 304. Promoting cessation of tobacco use under the maternal and
child health services block grant program.
Sec. 305. State option to provide family planning services and supplies
to individuals with incomes that do not
exceed a State's income eligibility level
for medical assistance.
Sec. 306. State option to extend the postpartum period for provision of
family planning services and supplies.
TITLE I--IMPROVING PREVENTIVE HEALTH BENEFITS UNDER MEDICARE
SEC. 101. THERAPY AND COUNSELING FOR CESSATION OF TOBACCO USE.
(a) Coverage.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended--
(1) in subparagraph (U), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (V)(iii), by adding ``and'' after the
semicolon at the end; and
(3) by adding at the end the following new subparagraph:
``(W) supplemental preventive health services (as defined
in subsection (ww));''.
(b) Services Described.--Section 1861 (42 U.S.C. 1395x) is amended
by adding at the end the following new subsection:
``Supplemental Preventive Health Services
``(ww) The term `supplemental preventive health services' means the
following:
``(1)(A) Therapy and counseling for cessation of tobacco
use for individuals who use tobacco products or who are being
treated for tobacco use that is furnished--
``(i) by or under the supervision of a physician;
or
``(ii) by any other health care professional who--
``(I) is legally authorized to furnish such
services under State law (or the State
regulatory mechanism provided by State law) of
the State in which the services are furnished;
and
``(II) is authorized to receive payment for
other services under this title or is
designated by the Secretary for this purpose.
``(B) Subject to subparagraph (C), such term is limited
to--
``(i) therapy and counseling services recommended
in `Treating Tobacco Use and Dependence: A Clinical
Practice Guideline', published by the Public Health
Service in June 2000, or any subsequent modification of
such Guideline; and
``(ii) such other therapy and counseling services
that the Secretary recognizes to be effective.
``(C) Such term shall not include coverage for drugs or
biologicals that are not otherwise covered under this title.''.
(c) Payment and Elimination of Cost-Sharing for All Supplemental
Preventive Health Services.--
(1) Payment and elimination of coinsurance.--Section
1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amended--
(A) in subparagraph (N), by inserting ``other than
supplemental preventive health services (as defined in
section 1861(ww))'' after ``(as defined in section
1848(j)(3))'';
(B) by striking ``and'' before ``(U)''; and
(C) by inserting before the semicolon at the end
the following: ``, and (V) with respect to supplemental
preventive health services (as defined in section
1861(ww)), the amount paid shall be 100 percent of the
lesser of the actual charge for the services or the
amount determined under the payment basis determined
under section 1848 by the Secretary for the particular
supplemental preventive health service involved''.
(2) Payment under physician fee schedule.--Section
1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
``(2)(W),'' after ``(2)(S),''.
(3) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) (42
U.S.C. 1395cc(a)(2)(A)) is amended by inserting after
``1861(s)(10)(A)'' the following: ``, with respect to
supplemental preventive health services (as defined in section
1861(ww)),''.
(4) Elimination of deductible.--The first sentence of
section 1833(b) (42 U.S.C. 1395l(b)) is amended--
(A) by striking ``and'' before ``(6)''; and
(B) by inserting before the period the following:
``, and (7) such deductible shall not apply with
respect to supplemental preventive health services (as
defined in section 1861(ww))''.
(d) Application of Limits on Billing.--Section 1842(b)(18)(C) (42
U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following
new clause:
``(vii) Any health care professional designated under
section 1861(ww)(1)(A)(ii)(II) to perform therapy and
counseling for cessation of tobacco use.''.
(e) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2004.
SEC. 102. COUNSELING FOR POST-MENOPAUSAL WOMEN.
(a) Coverage.--Section 1861(ww) (42 U.S.C. 1395x(s)(2)), as amended
by section 101(b), is amended by adding at the end the following new
paragraph:
``(2)(A) Counseling for post-menopausal women (as defined
in subparagraph (B)).
``(B)(i) For purposes of subparagraph (A), the term
`counseling for post-menopausal women' means counseling
provided to a post-menopausal woman regarding--
``(I) the symptoms, risk factors, and conditions
associated with menopause;
``(II) appropriate treatment options for post-
menopausal women, including hormone replacement
therapy; and
``(III) other interventions that can be implemented
to prevent or delay the onset of health risks
associated with menopause.
``(ii) Such term does not include coverage for drugs or
biologicals that are not otherwise covered under this title.''.
(b) Effective Date.--The amendment made by this section shall apply
to services furnished on or after January 1, 2004.
SEC. 103. SCREENING FOR DIMINISHED VISUAL ACUITY.
(a) Coverage.--Section 1861(ww) (42 U.S.C. 1395x(s)(2)), as amended
by section 102(a), is amended by adding at the end the following new
paragraph:
``(3)(A) Screening for diminished visual acuity (as defined
in subparagraph (B)).
``(B) For purposes of subparagraph (A), the term `screening
for diminished visual acuity' means a screening for diminished
visual acuity that is furnished by or under the supervision of
an optometrist or ophthalmologist who is legally authorized to
furnish such services under State law (or the State regulatory
mechanism provided by State law) of the State in which the
services are furnished.''.
(b) Effective Date.--The amendment made by this section shall apply
to services furnished on or after January 1, 2004.
SEC. 104. SCREENING FOR HEARING IMPAIRMENT.
(a) Coverage.--Section 1861(ww) (42 U.S.C. 1395x(s)(2)), as amended
by section 103(a), is amended by adding at the end the following new
paragraph:
``(4)(A) Screening for hearing impairment (as defined in
subparagraph (B)).
``(B) For purposes of subparagraph (A), the term `screening
for hearing impairment' means the following services:
``(i) A screening for hearing impairment using
periodic questions that is furnished by--
``(I) a physician, including an
otolaryngologist;
``(II) a qualified audiologist (as defined
in subsection (ll)(3)(B)); or
``(III) any other health care professional
who is legally authorized to furnish such
screening under State law (or the State
regulatory mechanism provided by State law) of
the State in which the screening is furnished.
``(ii) If the answers to such questions indicate
potential hearing impairment, an otoscopic examination
and an audiometric screening test that are furnished by
an otolaryngologist or a qualified audiologist (as so
defined).
``(iii) If the results of such examination or test
indicate a need for assistive listening devices
(whether or not such examination or test was based on a
screening or was diagnostic), counseling about such
devices that is furnished by an otolaryngologist or a
qualified audiologist (as so defined).''.
(b) Effective Date.--The amendment made by this section shall apply
to services furnished on or after January 1, 2004.
SEC. 105. EXPANSION OF ELIGIBILITY FOR BONE MASS MEASUREMENT.
(a) Expansion.--Paragraph (2) of section 1861(rr) (42 U.S.C.
1395x(rr)(2)) is amended to read as follows:
``(2) For purposes of this subsection, the term `qualified
individual' means an individual who is (in accordance with regulations
prescribed by the Secretary)--
``(A) an estrogen-deficient woman (including those
receiving hormone replacement therapy);
``(B) an individual with low trauma or fragility fractures
(including vertebral abnormalities and hip, rib, wrist, pelvic,
or proximal humeral fractures);
``(C) an individual receiving long-term medications that
have associations to bone loss or osteoporosis (including
glucocorticoid therapy and androgen deprivation therapy);
``(D) an individual with a long-term medical condition that
has association to osteoporosis (including primary
hyperparathyroidism);
``(E) a man with risk factors for osteoporosis such as
hypogonadism; and
``(F) an individual being monitored to assess the response
to, or efficacy of, an approved osteoporosis therapy.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to services furnished on or after January 1, 2004.
SEC. 106. COVERAGE OF CARDIOVASCULAR SCREENING TESTS.
(a) Services Described.--Section 1861(ww) (42 U.S.C. 1395x), as
amended by section 105(a), is amended by adding at the end the
following new paragraph:
``(5)(A) Cardiovascular screening tests for the early
detection of cardiovascular disease, including the following
diagnostic tests:
``(i) Tests for the determination of cholesterol
levels.
``(ii) Tests for the determination of lipid levels
of the blood.
``(iii) Screening for hypertension.
``(iv) Such other tests for cardiovascular disease
as the Secretary may approve.
``(B)(i) Subject to clause (ii), the Secretary shall
establish standards, in consultation with appropriate
organizations, regarding the frequency and type of
cardiovascular screening tests.
``(ii) With respect to the frequency of cardiovascular
screening tests approved by the Secretary under clause (i), in
no case may the frequency of such tests be more often than once
every 2 years.''.
(b) Frequency.--Section 1862(a)(1) (42 U.S.C. 1395y(a)(1)) is
amended--
(1) in subparagraph (H), by striking ``and'' at the end;
(2) in subparagraph (I), by striking the semicolon at the
end and inserting ``, and''; and
(3) by adding at the end the following new subparagraph:
``(J) in the case of a cardiovascular screening test which
is performed more frequently than is covered under section
1861(ww)(5)(B).''.
(c) Effective Date.--The amendments made by this section shall
apply to tests furnished on or after January 1, 2004.
SEC. 107. COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES FOR
BENEFICIARIES WITH CARDIOVASCULAR DISEASES.
(a) In General.--Section 1861(s)(2)(V) (42 U.S.C. 1395x(s)(2)(V))
is amended to read as follows:
``(V) medical nutrition therapy services (as defined in
subsection (vv)(1)) in the case of a beneficiary--
``(i) with a cardiovascular disease (including
congestive heart failure, arteriosclerosis,
hyperlipidemia, hypertension, and
hypercholesterolemia), diabetes, or a renal disease (or
a combination of such conditions) who--
``(I) has not received diabetes outpatient
self-management training services within a time
period determined by the Secretary;
``(II) is not receiving maintenance
dialysis for which payment is made under
section 1881; and
``(III) meets such other criteria
determined by the Secretary after consideration
of protocols established by dietitian or
nutrition professional organizations; or
``(ii) with a combination of such conditions who--
``(I) is not described in clause (i)
because of the application of subclause (I) or
(II) of such clause;
``(II) receives such medical nutrition
therapy services in a coordinated manner (as
determined appropriate by the Secretary) with
any services described in such subclauses that
the beneficiary is receiving; and
``(III) meets such other criteria
determined by the Secretary after consideration
of protocols established by dietitian or
nutrition professional organizations,
for such number of hours as the Secretary may specify, except
that, in the case of a beneficiary with a cardiovascular
disease, such number may not exceed 3 hours in a year without a
determination of a physician that additional hours are
medically necessary in that year due to a change in medical
condition, diagnosis, or treatment regime of the patient;''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to services furnished on or after January 1, 2004.
SEC. 108. MEDICARE COVERAGE OF DIABETES LABORATORY DIAGNOSTIC TESTS.
(a) Coverage.--Section 1861(ww) (42 U.S.C. 1395x(ww)), as amended
by section 107(a), is amended by adding at the end the following new
paragraph:
``(7)(A) Diabetes screening tests (as defined in
subparagraph (B)(i)) for individuals at risk for diabetes (as
defined in subparagraph (B)(ii)) not more frequently than is
covered under subparagraph (C).
``(B)(i) For purposes of this paragraph, the term `diabetes
screening tests' means diagnostic testing furnished to an
individual at risk for diabetes for the purpose of early
detection of diabetes, including--
``(I) a fasting plasma glucose test; and
``(II) such other tests, and modifications to
tests, as the Secretary determines appropriate, in
consultation with appropriate organizations.
``(ii) For purposes of this paragraph, the term `individual
at risk for diabetes' means an individual who has any of the
following risk factors for diabetes:
``(I) A family history of diabetes.
``(II) Overweight defined as a body mass index
greater than or equal to 25 kg/m\2\.
``(III) Habitual physical inactivity.
``(IV) Belonging to a high-risk ethnic or racial
group.
``(V) Previous identification of an elevated
impaired fasting glucose.
``(VI) Identification of impaired glucose
tolerance.
``(VII) Hypertension.
``(VIII) Dyslipidemia.
``(IX) History of gestational diabetes mellitus or
delivery of a baby weighing greater than 9 pounds.
``(X) Polycystic ovary syndrome.
``(C) The Secretary shall establish standards, in
consultation with appropriate organizations, regarding the
frequency of diabetes screening tests, except that such
frequency may not be more often than twice within the 12-month
period following the date of the most recent diabetes screening
test of that individual.''.
(b) Frequency.--Section 1862(a)(1) (42 U.S.C. 1395y(a)(1)), as
amended by section 107(b), is amended--
(1) in subparagraph (J), by striking ``and'' at the end;
(2) in subparagraph (K), by striking the semicolon at the
end and inserting ``, and''; and
(3) by adding at the end the following new subparagraph:
``(L) in the case of a diabetes screening test (as defined
in section 1861(ww)(7)(B)(i)), which is performed more
frequently than is covered under section 1861(ww)(7)(C).''.
(c) Effective Date.--The amendments made by this section shall
apply to tests furnished on or after January 1, 2004.
SEC. 109. COVERAGE OF ANNUAL SCREENING PAP SMEAR AND PELVIC EXAMS.
(a) In General.--
(1) Annual screening pap smear.--Section 1861(nn)(1) (42
U.S.C. 1395x(nn)(1)) is amended by striking ``, if the
individual involved'' and all that follows before the period at
the end and inserting ``if the woman involved has not had such
a test during the preceding year''.
(2) Annual screening pelvic exam.--Section 1861(nn)(2) (42
U.S.C. 1395x(nn)(2)) is amended by striking ``during the
preceding 2 years, or during the preceding year in the case of
a woman described in paragraph (3),'' and inserting ``during
the preceding year,''.
(3) Conforming amendment.--Section 1861(nn) (42 U.S.C.
1395x(nn)) is amended by striking paragraph (3).
(b) Effective Date.--The amendments made by subsection (a) apply to
items and services furnished on or after January 1, 2004.
SEC. 110. ADJUSTMENTS TO LOCAL FEE SCHEDULES FOR CLINICAL LABORATORY
TESTS FOR IMPROVEMENT IN CERVICAL CANCER DETECTION.
Section 1833(h)(2) (42 U.S.C. 1395l(h)(2)) is amended by adding at
the end the following new subparagraph:
``(C) Notwithstanding any other provision of law, in the case of a
diagnostic test for the detection of cervical cancer utilizing
automated thin layer preparation techniques for specimens collected in
fluid medium, and for which a national limitation amount has been set
pursuant to the parenthetical in paragraph (4)(B)(viii), furnished on
or after January 1, 2004, and before January 1, 2006, the Secretary
shall permit carriers to raise their local fee schedule amount for
purposes of determining payment for such tests under this section, up
to, but not to exceed the national limitation amount previously
established for that test. Any such adjustment shall not affect such
national limitation amount.''.
SEC. 111. ENHANCED REIMBURSEMENT UNDER THE MEDICARE PROGRAM FOR
SCREENING AND DIAGNOSTIC MAMMOGRAPHY SERVICES; NOT
COUNTING CERTAIN RADIOLOGY RESIDENTS AGAINST GRADUATE
MEDICAL EDUCATION LIMITATIONS.
(a) Payments to Facilities for Screening and Diagnostic
Mammography.--
(1) In general.--Notwithstanding any other provision of
law, with respect to payment for a screening or diagnostic
mammography furnished to a medicare beneficiary, the amount of
payment made to a hospital-based facility (as defined in
paragraph (4)) in which such screening or diagnostic
mammography is performed during the applicable period described
in paragraph (3) is equal to 200 percent of the amount of
payment that would otherwise apply under the fee schedule
established under section 1848 of the Social Security Act (42
U.S.C. 1395w-4) with respect to the technical component of such
screening or diagnostic mammography.
(2) Temporary payment rule.--With respect to payments to a
hospital-based facility for screening or diagnostic mammography
described in paragraph (1) during the applicable period,
payment shall be made to the facility for such mammography
pursuant to this subsection and shall not be made under section
1833(t) of such Act (42 U.S.C. 1395l(t)).
(3) Applicable period.--The applicable period referred to
in paragraph (1) is the period beginning on the date of
enactment of this Act and ending on the date the Secretary
establishes and implements an appropriate facility payment rate
under the prospective payment system for covered outpatient
services under such section 1833(t) for a screening or
diagnostic mammography furnished to a medicare beneficiary, but
in no case less than the amount payment provided for in
paragraph (1).
(4) Hospital-based facility defined.--In this subsection,
the term ``hospital-based facility'' means a facility for which
payment is made for a diagnostic or screening mammography under
such section 1833(t) but for this subsection.
(b) Not Counting Certain Radiology Residents Against Graduate
Medical Education Limitations.--
(1) In general.--For cost reporting periods beginning on or
after October 1, 2003, and before October 1, 2008, in applying
the limitations regarding the total number of full-time
equivalent residents in the field of allopathic or osteopathic
medicine under subsections (d)(5)(B)(v) and (h)(4)(F) of
section 1886 of the Social Security Act (42 U.S.C. 1395ww) for
a hospital, the Secretary of Health and Human Services shall
not take into account 1 additional resident in the field of
radiology per post-graduate year during each such cost
reporting period to the extent the hospital increases the
number of radiology residents above the number of such
residents for the hospital's most recent cost reporting period
ending before October 1, 2003.
(2) Treatment for entire period of training program.--The
provisions of paragraph (1) shall apply for each year of the
full-time equivalent resident's approved medical residency
training program in the field of radiology not taken into
account by reason of paragraph (1).
(c) Construction.--Nothing in this section shall be construed as
affecting the provisions of section 104(d) of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 (114 Stat.
2763A-470), as enacted into law by section 1(a)(6) of Public Law 106-
554 (relating to payment for new technologies).
SEC. 112. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR EXISTING
PREVENTIVE HEALTH BENEFITS.
(a) In General.--Section 1833 (42 U.S.C. 1395l) is amended by
inserting after subsection (o) the following new subsection:
``(p) Deductibles and Coinsurance Waived for Preventive Health
Items and Services.--The Secretary may not require the payment of any
deductible or coinsurance under subsection (a) or (b), respectively, of
any individual enrolled for coverage under this part for any of the
following preventive health items and services:
``(1) Blood-testing strips, lancets, and blood glucose
monitors for individuals with diabetes described in section
1861(n).
``(2) Diabetes outpatient self-management training services
(as defined in section 1861(qq)(1)).
``(3) Pneumococcal, influenza, and hepatitis B vaccines and
administration described in section 1861(s)(10).
``(4) Screening mammography (as defined in section
1861(jj)).
``(5) Screening pap smear and screening pelvic exam (as
defined in paragraphs (1) and (2) of section 1861(nn),
respectively).
``(6) Bone mass measurement (as defined in section
1861(rr)(1)).
``(7) Prostate cancer screening test (as defined in section
1861(oo)(1)).
``(8) Colorectal cancer screening test (as defined in
section 1861(pp)(1)).
``(9) Screening for glaucoma (as defined in section
1861(uu)).
``(10) Medical nutrition therapy services (as defined in
section 1861(vv)(1)).''.
(b) Waiver of Coinsurance.--
(1) In general.--Section 1833(a)(1)(B) (42 U.S.C.
1395l(a)(1)(B)) is amended to read as follows:
``(B) with respect to preventive health items and
services described in subsection (p), the amounts paid
shall be 100 percent of the fee schedule or other basis
of payment under this title for the particular item or
service,''.
(2) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) (42
U.S.C. 1395cc(a)(2)(A)), as amended by section 101(c)(3), is
amended by inserting ``preventive health items and services
described in section 1833(p) and'' before ``supplemental
preventive health services''.
(c) Waiver of Application of Deductible.--Section 1833(b)(1) (42
U.S.C. 1395l(b)(1)) is amended to read as follows:
``(1) such deductible shall not apply with respect to
preventive health items and services described in subsection
(p),''.
(d) Adding ``Lancet'' to Definition of DME.--Section 1861(n) (42
U.S.C. 1395x(n)) is amended by striking ``blood-testing strips and
blood glucose monitors'' and inserting ``blood-testing strips, lancets,
and blood glucose monitors''.
(e) Conforming Amendments.--
(1) Elimination of coinsurance for clinical diagnostic
laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of
section 1833(a) (42 U.S.C. 1395l(a)) are each amended by
inserting ``or which are described in subsection (p)'' after
``assignment-related basis''.
(2) Elimination of coinsurance for certain dme.--Section
1834(a)(1)(A) (42 U.S.C. 1395m(a)(1)(A)) is amended by
inserting ``(or 100 percent, in the case of such an item
described in section 1833(p))'' after ``80 percent''.
(3) Elimination of deductibles and coinsurance for
colorectal cancer screening tests.--Section 1834(d) (42 U.S.C.
1395m(d)) is amended--
(A) in paragraph (2)(C)--
(i) by striking ``(C) Facility payment
limit.--'' and all that follows through
``Notwithstanding subsections'' and inserting
the following:
``(C) Facility payment limit.--Notwithstanding
subsections'';
(ii) by striking ``(I) in accordance'' and
inserting the following:
``(i) in accordance'';
(iii) by striking ``(II) are performed''
and all that follows through ``payment under''
and inserting the following:
``(ii) are performed in an ambulatory
surgical center or hospital outpatient
department, payment under''; and
(iv) by striking clause (ii); and
(B) in paragraph (3)(C)--
(i) by striking ``(C) Facility payment
limit.--'' and all that follows through
``Notwithstanding subsections'' and inserting the following:
``(C) Facility payment limit.--Notwithstanding
subsections''; and
(ii) by striking clause (ii).
(f) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2004.
TITLE II--IMPROVING MEDICARE FOR FAMILY CAREGIVERS BY COVERING ADULT
DAY SERVICES
SEC. 201. FINDINGS.
Congress finds that--
(1) adult day services offers services, including medical
care, rehabilitation therapies, dignified assistance with
activities of daily living, social interaction, and stimulating
activities, to seniors who are frail, physically challenged, or
cognitively impaired;
(2) access to adult day services provides seniors and their
familial caregivers support that is critical to keeping the
senior in the family home;
(3) more than 22,000,000 families in the United States
serve as caregivers for aging or ailing seniors, nearly 1 in 4
American families, providing close to 80 percent of the care to
individuals requiring long-term care;
(4) nearly 75 percent of those actively providing such care
are women who also maintain other responsibilities, such as
working outside of the home and raising young children;
(5) the average loss of income to these caregivers has been
shown to be $659,130 in wages, pension, and Social Security
benefits;
(6) the loss in productivity in United States businesses
ranges from $11,000,000,000 to $29,000,000,000 annually;
(7) the services offered in adult day services facilities
provide continuity of care and an important sense of community
for both the senior and the caregiver;
(8) there are adult day services facilities in every State
in the United States and the District of Columbia;
(9) these centers generally offer transportation, meals,
personal care, and counseling in addition to the medical
services and socialization benefits offered; and
(10) with the need for quality options in how to best care
for our senior population about to dramatically increase with
the aging of the baby boomer generation, the time to address
these issues is now.
SEC. 202. MEDICARE COVERAGE OF SUBSTITUTE ADULT DAY SERVICES.
(a) Substitute Adult Day Services Benefit.--
(1) In general.--Section 1861(m) of the Social Security Act
(42 U.S.C. 1395x(m)) is amended--
(A) in the matter preceding paragraph (1), by
inserting ``or (8)'' after ``paragraph (7)'';
(B) in paragraph (6), by striking ``and'' at the
end;
(C) in paragraph (7), by adding ``and'' at the end;
and
(D) by inserting after paragraph (7), the following
new paragraph:
``(8) substitute adult day services (as defined in
subsection (ww));''.
(2) Substitute adult day services defined.--Section 1861 of
the Social Security Act (42 U.S.C. 1395x) is amended by adding
at the end the following new subsection:
``Substitute Adult Day Services; Adult Day Services Facility
``(ww)(1)(A) The term `substitute adult day services' means the
items and services described in subparagraph (B) that are furnished to
an individual by an adult day services facility as a part of a plan
under subsection (m) that substitutes such services for some or all of
the items and services described in subparagraph (B)(i) furnished by a
home health agency under the plan, as determined by the physician
establishing the plan.
``(B) The items and services described in this subparagraph are the
following items and services:
``(i) Items and services described in paragraphs (1)
through (7) of subsection (m).
``(ii) Meals.
``(iii) A program of supervised activities designed to
promote physical and mental health and furnished to the
individual by the adult day services facility in a group setting for a
period of not fewer than 4 and not greater than 12 hours per day.
``(iv) A medication management program (as defined in
subparagraph (C)).
``(C) For purposes of subparagraph (B)(iv), the term `medication
management program' means a program of services, including medicine
screening and patient and health care provider education programs, that
provides services to minimize--
``(i) unnecessary or inappropriate use of prescription
drugs; and
``(ii) adverse events due to unintended prescription drug-
to-drug interactions.
``(2)(A) Except as provided in subparagraphs (B) and (C), the term
`adult day services facility' means a public agency or private
organization, or a subdivision of such an agency or organization,
that--
``(i) is engaged in providing skilled nursing services and
other therapeutic services directly or under arrangement with a
home health agency;
``(ii) provides the items and services described in
paragraph (1)(B); and
``(iii) meets the requirements of paragraphs (2) through
(8) of subsection (o).
``(B) Notwithstanding subparagraph (A), the term `adult day
services facility' shall include a home health agency in which the
items and services described in clauses (ii) through (iv) of paragraph
(1)(B) are provided--
``(i) by an adult day services program that is licensed or
certified by a State, or accredited, to furnish such items and
services in the State; and
``(ii) under arrangements with that program made by such
agency.
``(C) The Secretary may waive the requirement of a surety bond
under paragraph (7) of subsection (o) in the case of an agency or
organization that provides a comparable surety bond under State law.''.
(b) Payment for Substitute Adult Day Services.--Section 1895 of the
Social Security Act (42 U.S.C. 1395fff) is amended by adding at the end
the following new subsection:
``(f) Payment Rate for Substitute Adult Day Services.--
``(1) Payment rate.--For purposes of making payments to an
adult day services facility for substitute adult day services
(as defined in section 1861(ww)), the following rules shall
apply:
``(A) Estimation of payment amount.--The Secretary
shall estimate the amount that would otherwise be
payable to a home health agency under this section for
all home health services described in paragraph
(1)(B)(i) of such section under the plan of care.
``(B) Amount of payment.--Subject to paragraph
(3)(B), the total amount payable for substitute adult
day services under the plan of care is equal to 95
percent of the amount estimated to be payable under
subparagraph (A).
``(2) Limitation on balance billing.--An adult day services
facility shall accept as payment in full for substitute adult
day services (including those services described in clauses
(ii) through (iv) of section 1861(ww)(1)(B)) furnished by the
facility to an individual entitled to benefits under this title
the amount of payment provided under this subsection for home
health services consisting of substitute adult day services.
``(3) Adjustment in case of overutilization of substitute
adult day services.--
``(A) Monitoring expenditures.--Beginning with
fiscal year 2005, the Secretary shall monitor the
expenditures made under this title for home health
services, including such services consisting of
substitute adult day services, for the fiscal year and
shall compare such expenditures to expenditures that
the Secretary estimates would have been made under this
title for home health services for the fiscal year if
the Improving Women's Health Act of 2003 had not been
enacted.
``(B) Required reduction in payment rate.--If the
Secretary determines, after making the comparison under
subparagraph (A) and making such adjustments for
changes in demographics and age of the medicare
beneficiary population as the Secretary determines
appropriate, that expenditures for home health services
under the this title, including such services
consisting of substitute adult day services, for the
fiscal year exceed expenditures that would have been
made under this title for home health services for the
fiscal year if the Improving Women's Health Act of 2003
not been enacted, then the Secretary shall adjust the
rate of payment to adult day services facilities under
paragraph (1)(B) for home health services consisting of
substitute adult day services furnished in the fiscal
year in order to eliminate such excess.''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2004.
TITLE III--IMPROVING AND EXPANDING PRENATAL CARE FOR LOW-INCOME WOMEN
SEC. 301. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN PREGNANT
WOMEN UNDER MEDICAID AND SCHIP.
(a) Medicaid.--
(1) Authority to expand coverage.--Section 1902(l)(2)(A)(i)
(42 U.S.C. 1396a(l)(2)(A)(i)) is amended by inserting ``(or
such higher percentage as the State may elect for purposes of
expenditures for medical assistance for pregnant women
described in section 1905(u)(4)(A))'' after ``185 percent''.
(2) Enhanced matching funds available if certain conditions
met.--Section 1905 (42 U.S.C. 1396d) is amended--
(A) in the fourth sentence of subsection (b), by
striking ``or subsection (u)(3)'' and inserting ``,
(u)(3), or (u)(4)''; and
(B) in subsection (u)--
(i) by redesignating paragraph (4) as
paragraph (5); and
(ii) by inserting after paragraph (3) the
following new paragraph:
``(4) For purposes of the fourth sentence of subsection (b) and
section 2105(a), the expenditures described in this paragraph are the
following:
``(A) Certain pregnant women.--If the conditions described
in subparagraph (B) are met, expenditures for medical
assistance for pregnant women described in subsection (n) or
under section 1902(l)(1)(A) in a family the income of which
exceeds 185 percent of the poverty line, but does not exceed
the income eligibility level established under title XXI for a
targeted low-income child.
``(B) Conditions.--The conditions described in this
subparagraph are the following:
``(i) The State plans under this title and title
XXI do not provide coverage for pregnant women
described in subparagraph (A) with higher family income
without covering such pregnant women with a lower
family income.
``(ii) The State does not apply an effective income
level for pregnant women that is lower than the
effective income level (expressed as a percent of the
poverty line and considering applicable income
disregards) that has been specified under the State
plan under subsection (a)(10)(A)(i)(III) or (l)(2)(A)
of section 1902, as of January 1, 2003, to be eligible
for medical assistance as a pregnant woman.
``(C) Definition of poverty line.--In this subsection, the
term `poverty line' has the meaning given such term in section
2110(c)(5).''.
(3) Payment from title xxi allotment for medicaid expansion
costs; elimination of counting medicaid child presumptive
eligibility costs against title xxi allotment.--Section
2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is amended--
(A) in the matter preceding subparagraph (A), by
striking ``(or, in the case of expenditures described
in subparagraph (B), the Federal medical assistance
percentage (as defined in the first sentence of section
1905(b)))''; and
(B) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) for the provision of medical assistance that
is attributable to expenditures described in section
1905(u)(4)(A);''.
(b) SCHIP.--
(1) Coverage.--Title XXI (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following new section:
``SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN.
``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State may provide for coverage, through an amendment to
its State child health plan under section 2102, of pregnancy-related
assistance for targeted low-income pregnant women in accordance with
this section, but only if--
``(1) the State has established an income eligibility level
for pregnant women under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 that is at least 185 percent of the
income official poverty line; and
``(2) the State meets the conditions described in section
1905(u)(4)(B).
``(b) Definitions.--For purposes of this title:
``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
pregnant women, except that the assistance shall be limited to
services related to pregnancy (which include prenatal,
delivery, and postpartum services and services described in
section 1905(a)(4)(C)) and to other conditions that may
complicate pregnancy.
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means a woman--
``(A) during pregnancy and through the end of the
month in which the 60-day period (beginning on the last
day of her pregnancy) ends;
``(B) whose family income exceeds the effective
income level (expressed as a percent of the poverty
line and considering applicable income disregards) that
has been specified under subsection (a)(10)(A)(i)(III)
or (l)(2)(A) of section 1902, as of January 1, 2003, to
be eligible for medical assistance as a pregnant woman
under title XIX but does not exceed the income
eligibility level established under the State child
health plan under this title for a targeted low-income
child; and
``(C) who satisfies the requirements of paragraphs
(1)(A), (1)(C), (2), and (3) of section 2110(b).
``(c) References to Terms and Special Rules.--In the case of, and
with respect to, a State providing for coverage of pregnancy-related
assistance to targeted low-income pregnant women under subsection (a),
the following special rules apply:
``(1) Any reference in this title (other than in subsection
(b)) to a targeted low-income child is deemed to include a
reference to a targeted low-income pregnant woman.
``(2) Any such reference to child health assistance with
respect to such women is deemed a reference to pregnancy-
related assistance.
``(3) Any such reference to a child is deemed a reference
to a woman during pregnancy and the period described in
subsection (b)(2)(A).
``(4) In applying section 2102(b)(3)(B), any reference to
children found through screening to be eligible for medical
assistance under the State medicaid plan under title XIX is
deemed a reference to pregnant women.
``(5) There shall be no exclusion of benefits for services
described in subsection (b)(1) based on any preexisting
condition and no waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) shall apply.
``(6) Subsection (a) of section 2103 (relating to required
scope of health insurance coverage) shall not apply insofar as
a State limits coverage to services described in subsection
(b)(1) and the reference to such section in section
2105(a)(1)(C) is deemed not to require, in such case,
compliance with the requirements of section 2103(a).
``(7) In applying section 2103(e)(3)(B) in the case of a
pregnant woman provided coverage under this section, the
limitation on total annual aggregate cost-sharing shall be
applied to such pregnant woman.
``(8) The reference in section 2107(e)(1)(D) to section
1920A (relating to presumptive eligibility for children) is
deemed a reference to section 1920 (relating to presumptive
eligibility for pregnant women).
``(d) Automatic Enrollment for Children Born to Women Receiving
Pregnancy-Related Assistance.--If a child is born to a targeted low-
income pregnant woman who was receiving pregnancy-related assistance
under this section on the date of the child's birth, the child shall be
deemed to have applied for child health assistance under the State
child health plan and to have been found eligible for such assistance
under such plan or to have applied for medical assistance under title
XIX and to have been found eligible for such assistance under such
title, as appropriate, on the date of such birth and to remain eligible
for such assistance until the child attains 1 year of age. During the
period in which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child health or
medical assistance eligibility identification number of the mother
shall also serve as the identification number of the child, and all
claims shall be submitted and paid under such number (unless the State
issues a separate identification number for the child before such
period expires).''.
(2) Additional allotments for providing coverage of
pregnant women.--
(A) In general.--Section 2104 (42 U.S.C. 1397dd) is
amended by inserting after subsection (c) the following
new subsection:
``(d) Additional Allotments for Providing Coverage of Pregnant
Women.--
``(1) Appropriation; total allotment.--For the purpose of
providing additional allotments to States under this title,
there is appropriated, out of any money in the Treasury not
otherwise appropriated, for each of fiscal years 2004 through
2007, $200,000,000.
``(2) State and territorial allotments.--In addition to the
allotments provided under subsections (b) and (c), subject to
paragraphs (3) and (4), of the amount available for the
additional allotments under paragraph (1) for a fiscal year,
the Secretary shall allot to each State with a State child
health plan approved under this title--
``(A) in the case of such a State other than a
commonwealth or territory described in subparagraph
(B), the same proportion as the proportion of the
State's allotment under subsection (b) (determined
without regard to subsection (f)) to the total amount
of the allotments under subsection (b) for such States
eligible for an allotment under this paragraph for such
fiscal year; and
``(B) in the case of a commonwealth or territory
described in subsection (c)(3), the same proportion as
the proportion of the commonwealth's or territory's
allotment under subsection (c) (determined without
regard to subsection (f)) to the total amount of the
allotments under subsection (c) for commonwealths and
territories eligible for an allotment under this
paragraph for such fiscal year.
``(3) Use of additional allotment.--Additional allotments
provided under this subsection are not available for amounts
expended before October 1, 2003. Such amounts are available for
amounts expended on or after such date for child health
assistance for targeted low-income children, as well as for
pregnancy-related assistance for targeted low-income pregnant
women.
``(4) No payments unless election to expand coverage of
pregnant women.--No payments may be made to a State under this
title from an allotment provided under this subsection unless
the State provides pregnancy-related assistance for targeted
low-income pregnant women under this title, or provides medical
assistance for pregnant women under title XIX, whose family
income exceeds the effective income level applicable under
subsection (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 to a
family of the size involved as of January 1, 2003.''.
(B) Conforming amendments.--Section 2104 (42 U.S.C.
1397dd) is amended--
(i) in subsection (a), in the matter
preceding paragraph (1), by inserting ``subject
to subsection (d),'' after ``under this
section,'';
(ii) in subsection (b)(1), by inserting
``and subsection (d)'' after ``Subject to
paragraph (4)''; and
(iii) in subsection (c)(1), by inserting
``subject to subsection (d),'' after ``for a
fiscal year,''.
(3) Additional conforming amendments.--
(A) No cost-sharing for pregnancy-related
benefits.--Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2))
is amended--
(i) in the heading, by inserting ``or
pregnancy-related services'' after ``preventive
services''; and
(ii) by inserting before the period at the
end the following: ``or for pregnancy-related
services''.
(B) No waiting period.--Section 2102(b)(1)(B) (42
U.S.C. 1397bb(b)(1)(B)) is amended--
(i) in clause (i), by striking ``, and'' at
the end and inserting a semicolon;
(ii) in clause (ii), by striking the period
at the end and inserting ``; and''; and
(iii) by adding at the end the following
new clause:
``(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income pregnant woman.''.
(c) Other Amendments to Medicaid.--
(1) Eligibility of a newborn.--Section 1902(e)(4) (42
U.S.C. 1396a(e)(4)) is amended in the first sentence by
striking ``so long as the child is a member of the woman's
household and the woman remains (or would remain if pregnant)
eligible for such assistance''.
(2) Application of qualified entities to presumptive
eligibility for pregnant women under medicaid.--Section 1920(b)
(42 U.S.C. 1396r-1(b)) is amended by adding after paragraph (2)
the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined
in section 1920A(b)(3).''.
(d) Effective Date.--The amendments made by this section apply to
items and services furnished on or after October 1, 2003, without
regard to whether regulations implementing such amendments have been
promulgated.
SEC. 302. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID
PROGRAM AND SCHIP.
(a) Medicaid Program.--Section 1903(v) (42 U.S.C. 1396b(v)) is
amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following new paragraph:
``(4)(A) A State may elect (in a plan amendment under this title)
to provide medical assistance under this title for aliens who are
lawfully residing in the United States (including battered aliens
described in section 431(c) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996) and who are otherwise eligible
for such assistance, within any of the following eligibility
categories:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the pregnancy).
``(ii) Children.--Children (as defined under such plan),
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(B)(i) In the case of a State that has elected to provide medical
assistance to a category of aliens under subparagraph (A), no debt
shall accrue under an affidavit of support against any sponsor of such
an alien on the basis of provision of assistance to such category and
the cost of such assistance shall not be considered as an unreimbursed
cost.
``(ii) The provisions of sections 401(a), 402(b), 403, and 421 of
the Personal Responsibility and Work Opportunity Reconciliation Act of
1996 shall not apply to a State that makes an election under
subparagraph (A).''.
(b) Title XXI.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is
amended by adding at the end the following new subparagraph:
``(E) Section 1903(v)(4) (relating to optional
coverage of permanent resident alien children), but
only if the State has elected to apply such section to
that category of children under title XIX.''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2003, and apply to medical assistance and child
health assistance furnished on or after such date.
SEC. 303. PROMOTING CESSATION OF TOBACCO USE UNDER THE MEDICAID
PROGRAM.
(a) Dropping Exception From Medicaid Prescription Drug Coverage for
Tobacco Cessation Medications.--Section 1927(d)(2) (42 U.S.C. 1396r-
8(d)(2)) is amended--
(1) by striking subparagraph (E);
(2) by redesignating subparagraphs (F) through (J) as
subparagraphs (E) through (I), respectively; and
(3) in subparagraph (F) (as redesignated by paragraph (2)),
by inserting before the period at the end the following: ``,
except agents approved by the Food and Drug Administration for
purposes of promoting, and when used to promote, tobacco
cessation''.
(b) Requiring Coverage of Tobacco Cessation Counseling Services for
Pregnant Women.--Section 1905(a)(4) (42 U.S.C. 1396d(a)(4)) is
amended--
(1) by striking ``and'' before ``(C)''; and
(2) by inserting before the semicolon at the end the
following new subparagraph: ``; and (D) counseling for
cessation of tobacco use (as defined in section 1861(ww)) for
pregnant women''.
(c) Removal of Cost-Sharing for Tobacco Cessation Counseling
Services for Pregnant Women.--Section 1916 (42 U.S.C. 1396o) is amended
in each of subsections (a)(2)(B) and (b)(2)(B) by inserting ``, and
counseling for cessation of tobacco use (as defined in section
1861(ww))'' after ``complicate the pregnancy''.
(d) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the date that is 1 year after
the date of enactment of this Act.
SEC. 304. PROMOTING CESSATION OF TOBACCO USE UNDER THE MATERNAL AND
CHILD HEALTH SERVICES BLOCK GRANT PROGRAM.
(a) Quality Maternal and Child Health Services Includes Tobacco
Cessation Counseling and Medications.--Section 501 (42 U.S.C. 701) is
amended by adding at the end the following new subsection:
``(c) For purposes of this title, counseling for cessation of
tobacco use (as defined in section 1861(vv)), drugs and biologicals
used to promote smoking cessation, and the inclusion of antitobacco
messages in health promotion counseling shall be considered to be part
of quality maternal and child health services.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date that is 1 year after the date of enactment of
this Act.
SEC. 305. STATE OPTION TO PROVIDE FAMILY PLANNING SERVICES AND SUPPLIES
TO INDIVIDUALS WITH INCOMES THAT DO NOT EXCEED A STATE'S
INCOME ELIGIBILITY LEVEL FOR MEDICAL ASSISTANCE.
(a) In General.--Title XIX (42 U.S.C. 1396 et seq.) is amended--
(1) by redesignating section 1935 as section 1936; and
(2) by inserting after section 1934 the following new
section:
``state option to provide family planning services and supplies
``Sec. 1935. (a) In General.--Subject to subsections (b) and (c), a
State may elect (through a State plan amendment) to make medical
assistance described in section 1905(a)(4)(C) available to any
individual whose family income does not exceed the greater of--
``(1) 185 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
``(2) the eligibility income level (expressed as a
percentage of such poverty line) that has been specified under
a waiver authorized by the Secretary or under section
1902(r)(2)), as of October 1, 2003, for an individual to be
eligible for medical assistance under the State plan.
``(b) Comparability.--Medical assistance described in section
1905(a)(4)(C) that is made available under a State plan amendment under
subsection (a) shall--
``(1) not be less in amount, duration, or scope than the
medical assistance described in that section that is made
available to any other individual under the State plan; and
``(2) be provided in accordance with the restrictions on
deductions, cost sharing, or similar charges imposed under
section 1916(a)(2)(D).
``(c) Option To Extend Coverage During a Post-Eligibility Period.--
``(1) Initial period.--A State plan amendment made under
subsection (a) may provide that any individual who was
receiving medical assistance described in section 1905(a)(4)(C)
as a result of such amendment, and who becomes ineligible for
such assistance because of hours of, or income from,
employment, may remain eligible for such medical assistance
through the end of the 6-month period that begins on the first
day the individual becomes so ineligible.
``(2) Additional extension.--A State plan amendment made
under subsection (a) may provide that any individual who has
received medical assistance described in section 1905(a)(4)(C)
during the entire 6-month period described in paragraph (1) may
be extended coverage for such assistance for a succeeding 6-
month period.''.
(b) Effective Date.--The amendments made by subsection (a) apply to
medical assistance provided on and after October 1, 2003.
SEC. 306. STATE OPTION TO EXTEND THE POSTPARTUM PERIOD FOR PROVISION OF
FAMILY PLANNING SERVICES AND SUPPLIES.
(a) In General.--Section 1902(e)(5) (42 U.S.C. 1396a(e)(5)) is
amended--
(1) by striking ``eligible under the plan, as though'' and
inserting ``eligible under the plan--
``(A) as though'';
(2) by striking the period and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(B) for medical assistance described in section
1905(a)(4)(C) for so long as the family income of such woman
does not exceed the maximum income level established by the
State for the woman to be eligible for medical assistance under
the State plan (as a result of pregnancy or otherwise).''.
(b) Effective Date.--The amendments made by subsection (a) apply to
medical assistance provided on and after October 1, 2003.
<all>