Coronavirus Medicaid Response Act

I 117TH CONGRESS 1ST SESSION H. R. 1353 To amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 25, 2021 Mrs. LEE of Nevada (for herself, Mr. HORSFORD, Mr. VARGAS, Mr. GRI- JALVA, Ms. TITUS, Ms. MOORE of Wisconsin, Ms. BARRAGA´N, Ms. WASSERMAN SCHULTZ, Ms. UNDERWOOD, Mr. CARSON, Mr. SAN NICO- LAS, Ms. NORTON, Mr. COHEN, Ms. TLAIB, Mrs. HAYES, Mr. THOMPSON of Mississippi, Mr. EVANS, Mr. HASTINGS, Ms. DEAN, Mr. JONES, Mr. LARSON of Connecticut, Mr. GARCI´A of Illinois, Ms. CRAIG, Ms. SCHA- KOWSKY, Mr. SMITH of Washington, Ms. CHU, Ms. MCCOLLUM, Mr. PETERS, Mr. DANNY K. DAVIS of Illinois, Mrs. WATSON COLEMAN, Ms. SHERRILL, Ms. DELBENE, Ms. SEWELL, Ms. WILD, Mr. SCHIFF, Ms. KUSTER, Ms. LOIS FRANKEL of Florida, Mr. RYAN, Mr. MEEKS, Ms. PORTER, Mrs. BEATTY, Mrs. DINGELL, Ms. SCHRIER, Mr. BERA, Ms. DELAURO, Mr. KILMER, Mr. SUOZZI, Mr. NEGUSE, and Mr. RUIZ) intro- duced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during eco- nomic downturns, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1353 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Coronavirus Medicaid 2 Response Act’’. 3 SEC. 2. INCREASING FEDERAL SUPPORT TO STATE MED- 4 ICAID PROGRAMS DURING ECONOMIC 5 DOWNTURNS. 6 (a) IN GENERAL.—Section 1905 of the Social Secu- 7 rity Act (42 U.S.C. 1396d) is amended— 8 (1) in subsection (b), by striking ‘‘and (ff)’’ and 9 inserting ‘‘(ff), and (hh)’’; and 10 (2) by adding at the end the following new sub- 11 section: 12 ‘‘(hh) INCREASED FMAP DURING ECONOMIC 13 DOWNTURNS.— 14 ‘‘(1) IN GENERAL.—If a fiscal quarter that be- 15 gins on or after January 1, 2020, is an economic 16 downturn quarter (as defined in paragraph (2)) with 17 respect to a State, then the Federal medical assist- 18 ance percentage determined for the State and quar- 19 ter under subsection (b) shall be equal to the per- 20 centage determined for the State and quarter under 21 paragraph (3). 22 ‘‘(2) ECONOMIC DOWNTURN QUARTER.— 23 ‘‘(A) IN GENERAL.— 24 ‘‘(i) IN GENERAL.—In this subsection, 25 the term ‘economic downturn quarter’ 26 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1353 IH means, with respect to a State, a fiscal 1 quarter during which the State’s unem- 2 ployment rate for the quarter exceeds the 3 percentage determined for the State and 4 quarter under clause (ii). 5 ‘‘(ii) THRESHOLD PERCENTAGE.—The 6 percentage determined under this clause 7 for a State and fiscal quarter is the per- 8 centage equal to the lower of— 9 ‘‘(I) the State unemployment 10 rate at the 20th percentile of the dis- 11 tribution of the State’s quarterly un- 12 employment rates for the 60-quarter 13 period preceding the quarter involved, 14 increased by 1 percentage point; and 15 ‘‘(II) the State’s average quar- 16 terly unemployment rate for the 12- 17 quarter period preceding the quarter 18 involved, increased by 1 percentage 19 point. 20 ‘‘(B) UNEMPLOYMENT DATA.— 21 ‘‘(i) IN GENERAL.—Except as pro- 22 vided in clause (ii), for purposes of deter- 23 mining unemployment rates for a State 24 and a quarter under this paragraph, the 25 VerDate Sep 11 2014 20:59 Mar 30, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1353 IH Secretary shall use data from the Local 1 Area Unemployment Statistics from the 2 Bureau of Labor Statistics. 3 ‘‘(ii) APPLICATION TO CERTAIN TER- 4 RITORIES.—In the case of the Virgin Is- 5 lands, Guam, the Northern Mariana Is- 6 lands, American Samoa, or any other juris- 7 diction for which suitable data from the 8 Local Area Unemployment Statistics from 9 the Bureau of Labor Statistics are unavail- 10 able, the Secretary shall use data from the 11 U–3 unemployment measure of the Bureau 12 of Labor Statistics to make any necessary 13 determinations under subparagraph (A). 14 ‘‘(3) INCREASED FMAP DURING ECONOMIC 15 DOWNTURN QUARTER.— 16 ‘‘(A) IN GENERAL.—During a fiscal quar- 17 ter that is an economic downturn quarter with 18 respect to a State, the Federal medical assist- 19 ance percentage for the State and quarter de- 20 termined under subsection (b) shall be equal 21 to— 22 ‘‘(i) the Federal medical assistance 23 percentage determined for the State and 24 quarter under subsection (b) without re- 25 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1353 IH gard to this subsection (but including any 1 increase to such percentage for such quar- 2 ter made pursuant to section 6008(a) of 3 the Families First Coronavirus Response 4 Act); increased by 5 ‘‘(ii) the number of percentage points 6 (rounded to the nearest tenth of a percent- 7 age point) equal to the product of— 8 ‘‘(I) the number of percentage 9 points (rounded to the nearest tenth 10 of a percentage point) by which the 11 unemployment rate for the State and 12 quarter exceeds the percentage deter- 13 mined for the State and quarter 14 under paragraph (2)(A)(ii); and 15 ‘‘(II) 4.8. 16 ‘‘(B) RULES OF APPLICATION.—The fol- 17 lowing rules shall apply with respect to the Fed- 18 eral medical assistance percentage determined 19 for a State and an economic downturn quarter 20 under this subsection: 21 ‘‘(i) SCOPE OF APPLICATION.—Such 22 Federal medical assistance percentage shall 23 not apply for purposes of— 24 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1353 IH ‘‘(I) disproportionate share hos- 1 pital payments described in section 2 1923; 3 ‘‘(II) payments under part D of 4 title IV; or 5 ‘‘(III) any payments under this 6 title that are based on a Federal med- 7 ical assistance percentage determined 8 for a State under subsection (aa) (but 9 only to the extent that such Federal 10 medical assistance percentage is high- 11 er than the economic recovery 12 FMAP). 13 ‘‘(ii) LIMITATION.—In no case shall— 14 ‘‘(I) the Federal medical assist- 15 ance percentage determined for a 16 State and quarter pursuant to this 17 subsection exceed 95 percent; or 18 ‘‘(II) any increase to the Federal 19 medical assistance percentage deter- 20 mined for a State and quarter pursu- 21 ant to this subsection result in the ap- 22 plication of a Federal medical assist- 23 ance percentage that exceeds 95 per- 24 cent. 25 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 1353 IH ‘‘(iii) APPLICATION TO CHIP.—Not- 1 withstanding the first sentence of section 2 2105(b), the application of this subsection 3 may result in the enhanced FMAP of a 4 State for a fiscal year under such section 5 exceeding 85 percent, but in no case may 6 the application of this subsection before 7 application of the second sentence of such 8 section result in the enhanced FMAP of 9 the State exceeding 95 percent. 10 ‘‘(4) ADVANCE PAYMENT; RETROSPECTIVE AD- 11 JUSTMENT.— 12 ‘‘(A) IN GENERAL.—Prior to the beginning 13 of each fiscal quarter that begins on or after 14 July 1, 2020, the Secretary shall, with respect 15 to each State— 16 ‘‘(i) make an initial determination, 17 based on the projections made for the 18 State and quarter under subparagraph 19 (B), as to— 20 ‘‘(I) whether the application of 21 this subsection is expected to result in 22 the application of a higher Federal 23 medical assistance percentage for the 24 State and quarter than the percentage 25 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 1353 IH that would otherwise apply without re- 1 gard to this subsection; and— 2 ‘‘(II) if the application of this 3 subsection is expected to result in 4 such a higher Federal medical assist- 5 ance percentage for the State and 6 quarter, what such higher percentage 7 is expected to be; and 8 ‘‘(ii) if the Secretary determines under 9 clause (i) that the application of this sub- 10 section is expected to result in the applica- 11 tion of a higher Federal medical assistance 12 percentage for the State and quarter than 13 the percentage that would otherwise apply 14 without regard to this subsection— 15 ‘‘(I) apply such higher Federal 16 medical assistance percentage of the 17 State for purposes of making pay- 18 ments to the State for amounts ex- 19 pended during such quarter as med- 20 ical assistance under the State plan; 21 and 22 ‘‘(II) take into account such 23 higher Federal medical assistance per- 24 centage of the State for purposes of 25 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 1353 IH calculating the enhanced FMAP for 1 the State and quarter under section 2 2105(b). 3 ‘‘(B) PROJECTION OF STATE UNEMPLOY- 4 MENT RATES.—Prior to the beginning of each 5 fiscal quarter that begins on or after July 1, 6 2020, the Secretary, acting through the Chief 7 Actuary of the Centers for Medicare & Medicaid 8 Services, shall, using the most recently available 9 data described in paragraph (2)(B), make pro- 10 jections with respect to— 11 ‘‘(i) the unemployment rates for each 12 State for such quarter; 13 ‘‘(ii) the threshold percentages de- 14 scribed in paragraph (2)(A)(ii) for each 15 State for such quarter; and 16 ‘‘(iii) the national unemployment rate 17 for such quarter. 18 ‘‘(C) RETROSPECTIVE ADJUSTMENT.—As 19 soon as practicable after final unemployment 20 data becomes available for a fiscal quarter that 21 begins on or after July 1, 2020, the Secretary 22 shall, with respect to each State— 23 ‘‘(i) make a final determination with 24 respect to the application of this subsection 25 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 1353 IH for purposes of determining the Federal 1 medical assistance percentage and en- 2 hanced FMAP of the State for the quarter; 3 and 4 ‘‘(ii) in accordance with section 5 1903(d)(2) and section 2105(e), reduce or 6 increase the amount payable to the State 7 under section 1903(a) or section 2105 for 8 a subsequent fiscal quarter to the extent of 9 any overpayment or underpayment under 10 either such section which the Secretary de- 11 termines was made as a result of an incor- 12 rect initial determination under subpara- 13 graph (A)(i) with respect to the application 14 of this subsection for purposes of deter- 15 mining the Federal medical assistance per- 16 centage and enhanced FMAP of the State 17 for such prior fiscal quarter. 18 ‘‘(5) RETROSPECTIVE APPLICATION OF OVER- 19 THE-LIMIT FMAP INCREASES.— 20 ‘‘(A) IN GENERAL.—If a State has excess 21 percentage points with respect to an economic 22 downturn quarter and an applicable FMAP (as 23 determined under subparagraph (B)), the State 24 may elect to apply such excess percentage 25 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 1353 IH points to increase such applicable FMAP for 1 one or more quarters during the look-back pe- 2 riod for the State and economic downturn quar- 3 ter in accordance with this paragraph. 4 ‘‘(B) EXCESS PERCENTAGE POINTS.—For 5 purposes of this paragraph, the number of ex- 6 cess percentage points for a State, economic 7 downturn quarter, and an applicable FMAP 8 shall be equal to the number of percentage 9 points by which— 10 ‘‘(i) the applicable FMAP for the 11 State and quarter (after application of 12 paragraph (3) but without regard to sub- 13 paragraph (B)(ii) of such paragraph); ex- 14 ceeds 15 ‘‘(ii) 95 percent. 16 ‘‘(C) EFFECT OF APPLICATION OF EXCESS 17 PERCENTAGE POINTS.—If a State elects to 18 apply excess percentage points to an applicable 19 FMAP to a quarter during a look-back period 20 under this paragraph, the Secretary shall deter- 21 mine the additional amount of payment under 22 section 1903(a) to which the State would have 23 been entitled for such quarter if the applicable 24 FMAP (as so increased) had been in effect for 25 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 1353 IH such quarter, and shall treat such additional 1 amount as an underpayment for such quarter. 2 ‘‘(D) DISTRIBUTION OF EXCESS PERCENT- 3 AGE POINTS.—A State that has excess percent- 4 age points with respect to an economic down- 5 turn quarter and applicable FMAP may elect to 6 divide such points among more than 1 quarter 7 during the look-back period for such State and 8 quarter provided that no excess percentage 9 point (or fraction of an excess percentage point) 10 is applied to the applicable FMAP of more than 11 1 quarter. 12 ‘‘(E) LIMITATIONS.— 13 ‘‘(i) NO INCREASES OVER 100 PER- 14 CENT.—A State may not increase an appli- 15 cable FMAP for any quarter during a look- 16 back period under this paragraph if such 17 increase would result in the applicable 18 FMAP for such quarter exceeding 100 per- 19 cent. 20 ‘‘(ii) SCOPE OF APPLICATION.—Any 21 increase to an applicable FMAP of a State 22 for a fiscal quarter under this paragraph— 23 ‘‘(I) shall only apply with respect 24 to payments for amounts expended by 25 VerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353 pamtmann on DSKBC07HB2PROD with BILLS 13 •HR 1353 IH the State for medical assistance for 1 services furnished during such quarter 2 to which such applicable FMAP is ap- 3 plicable; and 4 ‘‘(II) shall not apply with respect 5 to payments described in paragraph 6 (3)(B)(i). 7 ‘‘(F) DEFINITIONS.—In this paragraph: 8 ‘‘(i) APPLICABLE FMAP.—The term 9 ‘applicable FMAP’ means, with respect to 10 a State and fiscal quarter— 11 ‘‘(I) the Federal medical assist- 12 ance percentage determined for the 13 State and quarter under subsection 14 (b); 15 ‘‘(II) the Federal medical assist- 16 [Text truncated for display. 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