COVERAGE AND PAYMENT FOR PREGNANT WOMEN AND INFANTS WITH INCOMES BELOW POVERTY LINE.

SEC. 302. COVERAGE AND PAYMENT FOR PREGNANT WOMEN AND INFANTS WITH INCOMES BELOW POVERTY LINE. (a) Pregnant Women and Infants Under Age 1.— 102 STAT. 751 (1) Requiring coverage.— Section 1902(a)(10) (42 U.S.C. 1396a(a)(10)) is amended— (A) in subparagraph (A)(i), by striking “or” at the end of subclause (II), by striking the semicolon in subclause (III) and inserting “, or”, and by adding at the end the following new subclause: “(IV) who are described in subparagraph (A) or (B) of subsection (1)(1)and whose family income does not exceed the minimum income level the State is required to establish under subsection (1)(2)(A) for such a family;”; (B) by amending subclause (IX) of subparagraph (A)(ii) to read as follows: “(IX) who are described in subsection (l)(1) and are not described in clause (i)(IV);”; and (C) in clause (VII) in the matter after and below subparagraph (E), by inserting “(A)(i)(IV) or” before “(A)(ii)(IX)”. (2) Description of individuals required to be covered.— Section 1902(1) (42 U.S.C. 1396a(D) is amended— (A) in paragraph (1)(C)— (i) by inserting “at the option of the State,” after “(C)”, and (ii) by striking “and” after “1983,”; and (B) in paragraph (2)(A)— (i) by striking “not more than 185 percent)” and inserting “(not less than the percentage provided under clause (ii) and not more than 185 percent)”; (ii) by inserting “(i)” after “(2)(A)”; and (iii) by adding at the end the following new clause: “(ii) Subject to clause (iii), the percentage provided under this clause, with respect to eligibility for medical assistance on or after— “(I) July 1, 1989, is 75 percent, and “(II) July 1, 1990, is 100 percent. “(iii) In the case of a State which, as of the date of the enactment of this clause, has elected to provide, and provides, medical assistance to individuals described in this subsection or has enacted legislation authorizing, or appropriating funds, to provide such assistance to such individuals before July 1, 1989, the percentage provided under clause (ii) shall not be less than— “(I) the percentage specified by the State in an amendment to its State plan (whether approved or not) as of the date of the enactment of this clause, or “(II) if no such percentage is specified as of the date of the enactment of this clause, the percentage established under the State’s authorizing legislation or provided for under the State’s appropriations; but in no case shall this clause require the percentage provided under clause (ii) to exceed 100 percent.”. (b) Coverage of Medically Necessary Services for Infants and Assuring Adequate Payment for Inpatient Hospital Services for Infants in Disproportionate Share Hospitals.— (1) Coverage of medically necessary services for infants.— Section 1902(a)(10) (42 U.S.C. 1396a(a)(10)) is amended, in the matter after and below subparagraph (E)— (A) by striking “and” before “(IX)”, and (B) by inserting before the semicolon at the end the following: “, and (X) if the plan provides for any fixed 102 STAT. 752 durational limit on medical assistance for inpatient hospital services (whether or not such a limit varies by medical condition or diagnosis), the plan must establish exceptions to such a limit for medically necessary inpatient hospital services furnished with respect to individuals under one year of age in a hospital defined under the State plan, pursuant to section 1923(a)(1)(A), as a disproportionate share hospital and subparagraph (B) (relating to comparability) shall not be construed as requiring such an exception for other individuals, services, or hospitals”. (2) Assuring adequate payment for inpatient hospital services for infants in disproportionate share hospitals.— Section 1923(a)(2), as redesignated pursuant to the amendment made by section 411(k)(6)(B) of this Act, is amended by adding at the end the following new subparagraph: “(C) If a State plan under this title provides for payments for inpatient hospital services on a prospective basis (whether per diem, per case, or otherwise), in order for the plan to be considered to have met such requirement of section 1902(a)(13)(A) as of July 1, 1989, the State must submit to the Secretary by not later than April 1, 1989, a State plan amendment that provides, in the case of hospitals defined by the State as disproportionate share hospitals under paragraph (1)(A), for an outlier adjustment in payment amounts for medically necessary inpatient hospital services provided on or after July 1, 1989, involving exceptionally high costs or exceptionally long lengths of stay for individuals under one year of age.”. (c) Certain State Plan Requirements.— (1) In general.—Subsection (c) of section 1902 (42 U.S.C. 1396a) is amended to read as follows: “(c) Notwithstanding subsection (b), the Secretary shall not approve any State plan for medical assistance if— “(1) the State has in effect, under its plan established under part A of title IV, payment levels that are less than the payment levels in effect under such plan on May 1, 1988; or “(2) the State requires individuals described in subsection (1)(1) to apply for benefits under such part as a condition of applying for, or receiving, medical assistance under this title.”. (2) Eliminating duplicate requirement.—Section 1902(1) (42 U.S.C. 1396a(D) is amended by striking paragraph (4). (3) Maintenance of effort to receive medical assistance for optional coverage of pregnant women and children.— Section 1903(i) (42 U.S.C. 1396b(i)) is amended— (A) by striking the period at the end of paragraph (8) and inserting “; or”, and (B) by inserting after paragraph (8) the following new paragraph: “(9) with respect to any amount of medical assistance for pregnant women and children described in section 1902(a)(10)(A)(ii)(IX), if the State has in effect, under its plan established under part A of title IV, payment levels that are less than the payment levels in effect under such plan on July 1, 1987.”. (d) Treatment of Certain States and Territories.— Section 1902(1) (42 U.S.C. 1396a(1)) is amended by adding at the end the following new paragraph: “(4) (A) In the case of any State which is providing medical assistance to its residents under a waiver granted under section 1115, the 102 STAT. 753Secretary shall require the State to provide medical assistance for pregnant women and infants under age 1 described in subsection (a)(10)(A)(i)(IV) in the same manner as the State would be required to provide such assistance for such individuals if the State had in effect a plan approved under this title. “(B) In the case of a State which is not one of the 50 States or the District of Columbia, the State need not meet the requirement of subsection (a)(10)(A)(i)(IV) and, for purposes of paragraph (2)(A), the State may substitute for the percentage provided under clause (ii) of such paragraph any percentage.”. (e) Conforming Amendments.— (1) Section 1902(e)(6) (42 U.S.C. 1396a(e)(6)) is amended to read as follows: “(6) At the option of a State, in the case of a pregnant woman described in subsection (a)(10) who, because of a change in income of the family of which she is a member, would not otherwise continue to be described in such subsection, the State plan may nonetheless treat the woman as being an individual described in subsection (a)(10)(A)(i)(IV) and subsection (1)(1)(A) without regard to such change of income through the end of the month in which the 60-day period (beginning on the last day of her pregnancy) ends.”. (2) Section 1902(e)(7) (42 U.S.C. 1396a(e)(7)) is amended— (A) by striking “If a State plan provides medical assistance for individuals under subsection (a)(10)(A)(ii)(I)(), in” and inserting “In”, (B) by inserting “or paragraph (2) of section 1905(n)” after “subsection (1)(1)” the first place it appears, and (C) by striking “subsection (a)(10)(A)(ii)(I)() and subsection (1)(1)” and inserting “such respective provision”. (3) Section 1902(1) (42 U.S.C. 1396a(D) is amended— (A) in the matter after and below subparagraph (C) of paragraph (1), by inserting “any of subclauses (I) through (III) of” after “who are not described in”, and (B) in paragraph (3), in the matter before subparagraph (A), by inserting “(a)(10)(A)(i)(IV) or” before “(a)(10)(A)(ii)(I)()”. (4) Section 1903(f)(4) (42 U.S.C. 1396b(f)(4)) is amended, in the matter before subparagraph (A), by inserting “1902(a)(10)(A)(i)(IV),” before “1902(a)(10)(A)(ii)(IX)”. (f) Effective Date.— (1) In general.—The amendments made by this section apply (except as provided in this subsection) to payments under title XIX of the Social Security Act for calendar quarters beginning on or after July 1, 1989, with respect to eligibility for medical assistance on or after such date, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date. (2) Payment adjustment.—The amendments made by subsection (b)(2) shall take effect on the date of the enactment of this Act. (3) Delay for state legislation.—In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section (other than subsection (b)(2)), the State plan shall not be regarded as failing 102 STAT. 754to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a regular legislative session of 2 years, each year of such session shall be deemed to be a separate regular session of the State legislature.