Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 1722 To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico. IN THE HOUSE OF REPRESENTATIVES MARCH 9, 2021 Ms. VELA´ZQUEZ (for herself, Mr. ESPAILLAT, Ms. OCASIO-CORTEZ, Mr. GARCI´A of Illinois, Mr. GRIJALVA, and Miss GONZA´LEZ-COLO´N) intro- duced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Puerto Rico Health 4 Care Fairness, Accountability, and Beneficiary Access Act 5 of 2021’’. 6 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1722 IH SEC. 2. ADJUSTMENTS TO FMAP AND CAP FOR PUERTO 1 RICO. 2 (a) ADJUSTMENTS TO FMAP.—Section 1905 of the 3 Social Security Act (42 U.S.C. 1396d) is amended— 4 (1) in subsection (b) by inserting ‘‘(except for 5 Puerto Rico, for calendar quarters in a fiscal year 6 beginning with fiscal year 2022, shall be the PR 7 specified percent under subsection (hh) for such fis- 8 cal year)’’ after ‘‘shall be 55 percent’’; and 9 (2) by adding at the end the following new sub- 10 section: 11 ‘‘(hh) PR SPECIFIED PERCENT.— 12 ‘‘(1) IN GENERAL.—For purposes of subsection 13 (b), the PR specified percent under this subsection 14 is— 15 ‘‘(A) subject to paragraph (2), for each of 16 fiscal years 2022 through 2026, 83 percent; 17 ‘‘(B) subject to paragraph (3)(D)(iii), for 18 each of fiscal years 2027 through 2031, 83 per- 19 cent; and 20 ‘‘(C) subject to paragraph (3)(D)(iii), for 21 fiscal year 2032 and each subsequent fiscal 22 year, the Federal medical assistance percentage 23 calculated in accordance with the first sentence 24 of subsection (b), as such sentence applies to 25 the 50 States. 26 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1722 IH ‘‘(2) PROGRAM ENHANCEMENT INCENTIVES.— 1 ‘‘(A) IN GENERAL.—If Puerto Rico— 2 ‘‘(i) for fiscal year 2023, is in compliance 3 with none of the program enhancement require- 4 ments described in subparagraph (B), the PR 5 specified percent specified under paragraph (1) 6 for such fiscal year shall be reduced by 2 per- 7 cent; 8 ‘‘(ii) for fiscal year 2024, is in compliance 9 with fewer than two of the four program en- 10 hancement requirements described in subpara- 11 graph (B), the PR specified percent specified 12 under paragraph (1) for such fiscal year shall 13 be reduced by 3 percent; 14 ‘‘(iii) for fiscal year 2025, is in compliance 15 with fewer than three of the four program en- 16 hancement requirements described in subpara- 17 graph (B), the PR specified percent specified 18 under paragraph (1) for such fiscal year shall 19 be reduced by 5 percent; and 20 ‘‘(iv) for fiscal year 2026, is in compliance 21 with fewer than four of the program enhance- 22 ment requirements described in subparagraph 23 (B), the PR specified percent specified under 24 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1722 IH paragraph (1) for such fiscal year shall be re- 1 duced by 5 percent. 2 ‘‘(B) PROGRAM ENHANCEMENT REQUIRE- 3 MENTS.—For purposes of this subsection, the pro- 4 gram enhancement requirements described in this 5 subparagraph are each of the following: 6 ‘‘(i) Rates of payment under the State 7 plan under this title for inpatient hospital serv- 8 ices are not less than the costs incurred for 9 such services. 10 ‘‘(ii) Rates of payment under the State 11 plan under this title for physicians’ services are 12 not less than 70 percent of the amount that is 13 payable for such services under section 1848. 14 ‘‘(iii) The State plan provides for medical 15 assistance for Hepatitis C drugs, in accordance 16 with the requirements of section 1927 otherwise 17 applicable to the 50 States. 18 ‘‘(iv) The State plan provides for medical 19 assistance for Medicare cost-sharing described 20 in subsection (p)(3)(A)(ii) for qualified Medi- 21 care beneficiaries described in subsection (p)(1), 22 in accordance with the requirements under sub- 23 section (p) otherwise applicable to the 50 24 States. 25 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1722 IH ‘‘(3) TERRITORY TRANSITION PLAN.— 1 ‘‘(A) IN GENERAL.— 2 ‘‘(i) SUBMISSION OF PLAN.—Not later 3 than January 1, 2024, the Governor of Puerto 4 Rico shall submit to the Secretary a Territory 5 Transition Plan, which shall be developed with 6 stakeholder input and with a public comment 7 period, that includes— 8 ‘‘(I) a detailed description of which 9 program enhancements described in sub- 10 paragraph (C) Puerto Rico will include as 11 medical assistance under the State plan 12 under title XIX, the first plan year by 13 which each such program enhancement will 14 be so included in order to satisfy the re- 15 quirements described in subparagraph (B), 16 and a timeline for milestones for including 17 such program enhancements; and 18 ‘‘(II) a description of any challenges, 19 including infrastructure challenges, pro- 20 vider shortages, and financing challenges, 21 for so including such program enhance- 22 ments and a plan to ameliorate any such 23 challenges. 24 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1722 IH ‘‘(ii) NOTIFICATION OF PLAN APPROVAL.— 1 The plan submitted under clause (i) shall be 2 treated as approved by the Secretary not later 3 than 180 days after the date of submission of 4 the plan unless within such 180-day period the 5 Secretary disapproves such plan and notifies 6 Puerto Rico of such disapproval with the reason 7 for such disapproval. In the case of such a dis- 8 approval, the Governor of Puerto Rico shall, 9 within the 90-day period following such notifi- 10 cation, submit to the Secretary a Territory 11 Transition Plan that addresses the reason spec- 12 ified in such notification for such disapproval. 13 Such resubmitted plan shall be treated as ap- 14 proved by the Secretary under this clause un- 15 less the Secretary notifies Puerto Rico within 16 the 30-day period following such submission of 17 its disapproval with a reason for such dis- 18 approval. The Governor of Puerto Rico may de- 19 velop and submit to the Secretary, in the same 20 manner and subject to the same conditions as 21 apply under clause (i) to the development and 22 submission of the Territory Transition Plan, 23 modifications to the plan and such modifica- 24 tions shall be treated as approved by the Sec- 25 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 1722 IH retary and incorporated into the plan in the 1 same manner and subject to the same condi- 2 tions that apply under this clause to the ap- 3 proval of the plan. 4 ‘‘(B) REQUIREMENTS DESCRIBED.—For pur- 5 poses of this paragraph, the requirements described 6 in this subparagraph, with respect to Puerto Rico, 7 are the following: 8 ‘‘(i) For 2029, the State plan under title 9 XIX includes at least 2 of the program en- 10 hancements described in subparagraph (C). 11 ‘‘(ii) For 2031, the State plan includes at 12 least 4 of such program enhancements. 13 ‘‘(iii) For 2033, the State plan includes at 14 least 6 of such program enhancements. 15 ‘‘(iv) For 2035 and each subsequent year, 16 the State plan includes all of such program en- 17 hancements. 18 ‘‘(C) PROGRAM ENHANCEMENTS DESCRIBED.— 19 For purposes of this paragraph, the program en- 20 hancements described in this subparagraph are the 21 following: 22 ‘‘(i) The State plan provides for medical 23 assistance to all individuals described in clause 24 (i) of section 1902(a)(10)(A)). 25 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 1722 IH ‘‘(ii) The State plan provides for inclusion 1 as medical assistance of home health services, 2 in accordance with section 1902(a)(10)(D). 3 ‘‘(iii) The State plan provides for inclusion 4 as medical assistance of nonemergency trans- 5 portation to medically necessary services. 6 ‘‘(iv) The State plan provides for inclusion 7 as medical assistance of services described in 8 subsection (a)(21) to all individuals described in 9 clause (i) of section 1902(a)(10)(A)). 10 ‘‘(v) The State plan provides for inclusion 11 as medical assistance of services described in 12 subsection (a)(17) to all individuals described in 13 such clause (other than subclause (VIII) of 14 such clause. 15 ‘‘(vi) The State plan provides for inclusion 16 as medical assistance of nursing facility serv- 17 ices, as defined in subsection (a)(4)(A). 18 ‘‘(vii) The State plan provides for inclusion 19 as medical assistance of early and periodic 20 screening, diagnosis, and treatment services 21 under subsection (a)(4)(B). 22 ‘‘(viii) The State plan provides for inclu- 23 sion as medical assistance of freestanding birth 24 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 1722 IH center services and other ambulatory services, 1 as described in subsection (a)(28). 2 ‘‘(D) REPORTS.— 3 ‘‘(i) For fiscal year 2024 and each subse- 4 quent fiscal year through fiscal year 2035— 5 ‘‘(I) the Comptroller General of the 6 United States shall review, and submit to 7 the Secretary and Congress a report on, 8 whether or not Puerto Rico is in compli- 9 ance with the timeline and achieving the 10 milestones described in the Territory Tran- 11 sition plan (as modified, if applicable) ap- 12 proved under subparagraph (A) and, be- 13 ginning with fiscal year 2029, whether 14 Puerto Rico is in compliance with the ap- 15 plicable requirements described in subpara- 16 graph (B); and 17 ‘‘(II) Puerto Rico shall submit to the 18 Secretary a report on the extent to which 19 Puerto Rico has met the timelines and 20 milestones included in such plan (as modi- 21 fied, if applicable). 22 ‘‘(ii) If, for a fiscal year described in clause 23 (i) after fiscal year 2026, the Comptroller Gen- 24 eral submits a report with a finding that Puerto 25 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 1722 IH Rico is not in compliance with the timeline or 1 with achieving milestones as described in sub- 2 clause (I) (or, with respect to a fiscal year after 3 fiscal year 2028, not in compliance with the ap- 4 plicable requirement under subparagraph (B)), 5 not later than 90 days after the date of such 6 finding, Puerto Rico shall submit to the Sec- 7 retary for approval a corrective action plan to 8 remedy such noncompliance. 9 ‘‘(iii) If, by not later than a period speci- 10 fied by the Secretary after the date of the sub- 11 mission (and approval) of a corrective action 12 plan under clause (ii), with respect to a fiscal 13 year after fiscal year 2026 for which a finding 14 of non-compliance was made under clause (i), 15 the Secretary determines that Puerto Rico has 16 not fulfilled the terms of such corrective action 17 plan, the PR specified percent specified under 18 paragraph (1) for the fiscal year involved shall 19 be reduced by 5 percent for the period begin- 20 ning with the month beginning after such deter- 21 mination and ending with the first month be- 22 ginning after the Secretary determines Puerto 23 Rico has fulfilled the terms of the corrective ac- 24 tion plan.’’. 25 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 1722 IH (b) TREATMENT OF CAP.—Section 1108(g) of the 1 Social Security Act (42 U.S.C. 1308(g)) is amended— 2 (1) in paragraph (2)— 3 (A) in the matter preceding subparagraph 4 (A), by striking ‘‘subject to and section 5 1323(a)(2) of the Patient Protection and Af- 6 fordable Care Act paragraphs (3) and (5)’’ and 7 inserting ‘‘subject to section 1323(a)(2) of the 8 Patient Protection and Affordable Care Act and 9 paragraphs (3), (5), and (7)’’; and 10 (B) in subparagraph (A)— 11 (i) by striking ‘‘Puerto Rico shall not 12 exceed the sum of’’ and inserting ‘‘Puerto 13 Rico shall not exceed— 14 ‘‘(i) in the case of a fiscal year before 15 fiscal year 2022, the sum of’’; 16 (ii) by striking ‘‘$100,000;’’ and in- 17 serting ‘‘$100,000; and’’; and 18 (iii) by adding at the end the fol- 19 lowing new clause: 20 ‘‘(ii) in the case of fiscal year 2022 21 and each subsequent fiscal year (before fis- 22 cal year 2027), the amount specified in 23 paragraph (6) for such fiscal year;’’; and 24 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 1722 IH (2) by adding at the end the following new 1 paragraphs: 2 ‘‘(6) APPLICATION TO PUERTO RICO FOR FIS- 3 CAL YEARS 2022 THROUGH 2026.—For purposes of 4 paragraph (2)(A)(ii), the amount specified in this 5 paragraph is— 6 ‘‘(A) for fiscal year 2022, $3,012,610,000; 7 ‘‘(B) for fiscal year 2023, $3,114,331,000; 8 ‘‘(C) for fiscal year 2024, $3,225,627,000; 9 ‘‘(D) for fiscal year 2025, $3,336,627,000; 10 and 11 ‘‘(E) for fiscal year 2026, $3,447,627,000. 12 ‘‘(7) PUERTO RICO EXCLUSION FROM PAYMENT 13 LIMITATION BEGINNING FISCAL YEAR 2027.—Begin- 14 ning with fiscal year 2027, there shall be no limita- 15 tion applied under this subsection (f) or this sub- 16 section on the total amount certified by the Sec- 17 retary under title XIX for payment to Puerto 18 Rico.’’. 19 (c) TEMPORARY INCREASE IN FEDERAL MATCH FOR 20 STATE PLAN ADMINISTRATIVE COSTS.—Section 21 1903(a)(7) of the Social Security Act (42 U.S.C. 22 1396b(a)(7)) is amended by inserting ‘‘(or, in the case of 23 VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722 pamtmann on DSKBC07HB2PROD with BILLS 13 •HR 1722 IH Puerto Rico for each of fiscal years 2022 through 2035, 1 100 percent)’’ after ‘‘50 per centum’’. 2 Æ VerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00 [Text truncated for display. Full text available on Congress.gov.]