Territorial Equity Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 2713 To provide for equitable treatment for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. IN THE HOUSE OF REPRESENTATIVES APRIL 20, 2021 Ms. VELA´ZQUEZ (for herself, Ms. OCASIO-CORTEZ, Mr. GRIJALVA, and Mr. TORRES of New York) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, Agriculture, Education and Labor, and Nat- ural Resources, for a period to be subsequently determined by the Speak- er, in each case for consideration of such provisions as fall within the ju- risdiction of the committee concerned A BILL To provide for equitable treatment for Puerto Rico, the Vir- gin Islands, Guam, the Northern Mariana Islands, and American Samoa. 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; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Territorial Equity Act of 2021’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 this Act is as follows: 7 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 2713 IH Sec. 1. Short title; table of contents. TITLE I—HEALTH EQUITY FOR THE TERRITORIES Subtitle A—Medicaid Sec. 101. Elimination of general Medicaid funding limitations (‘‘cap’’) for terri- tories. Sec. 102. Elimination of specific Federal medical assistance percentage (FMAP) limitation for territories; temporary increase in FMAP for Puerto Rico and the Virgin Islands to 100 percent. Sec. 103. Application of Medicaid waiver authority to all of the territories. Sec. 104. Permitting Medicaid DSH allotments for territories. Subtitle B—Medicare Part A Sec. 111. Calculation of Medicare DSH payments for IPPS hospitals in Puerto Rico. Sec. 112. Rebasing target amount for hospitals in territories. Sec. 113. Medicare DSH target adjustment for hospitals in territories. Subtitle C—Medicare Part B Sec. 121. Application of part B deemed enrollment process to residents of Puerto Rico; special enrollment period and limit on late enroll- ment penalties. Subtitle D—Medicare Advantage (Part C) Sec. 131. Adjustment in benchmark for low-base payment counties in Puerto Rico. Subtitle E—Medicare Part D Sec. 141. Improved use of allocated prescription drug funds by territories. Sec. 142. Report on treatment of territories under Medicare part D. Subtitle F—Miscellaneous Sec. 151. Medicaid and CHIP territory transparency and information. Sec. 152. Report on exclusion of territories from Exchanges. Sec. 153. Access to coverage for individuals in certain areas without any avail- able Exchange plans. TITLE II—INCLUSION OF THE TERRITORIES IN THE SUPPLEMENTAL NUTRITIONAL ASSISTANCE PROGRAM Sec. 201. Participation and transition of Puerto Rico, American Samoa, and the Northern Mariana Islands in supplemental nutrition assist- ance program. TITLE III—EQUITABLE TREATMENT FOR PUERTO RICO AND THE VIRGIN ISLANDS WITH RESPECT TO TAX CREDITS Sec. 301. Equitable treatment for residents of Puerto Rico and the Virgin Is- lands with respect to the earned income tax credit and the child tax credit. TITLE IV—LABOR EQUITY FOR PUERTO RICO VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 2713 IH Sec. 401. Minimum wage for young employees in Puerto Rico. Sec. 402. Overtime hours protections for workers in Puerto Rico. TITLE V—EXTENSION OF SUPPLEMENTAL SECURITY INCOME (SSI) PROGRAM TO ALL TERRITORIES Sec. 501. Extension of SSI program to all territories. TITLE I—HEALTH EQUITY FOR 1 THE TERRITORIES 2 Subtitle A—Medicaid 3 SEC. 101. ELIMINATION OF GENERAL MEDICAID FUNDING 4 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES. 5 (a) IN GENERAL.—Section 1108 of the Social Secu- 6 rity Act (42 U.S.C. 1308) is amended— 7 (1) in subsection (f), in the matter preceding 8 paragraph (1), by striking ‘‘and (h)’’ and inserting 9 ‘‘(h), and (i)’’; 10 (2) in subsection (g)(2), in the matter pre- 11 ceding subparagraph (A), by inserting ‘‘subsection 12 (i),’’ after ‘‘subject to’’; and 13 (3) by adding at the end the following new sub- 14 section: 15 ‘‘(i) SUNSET OF MEDICAID FUNDING LIMITATIONS 16 FOR PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE 17 NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 18 Subsections (f) and (g) shall not apply to Puerto Rico, 19 the Virgin Islands, Guam, the Northern Mariana Islands, 20 and American Samoa beginning with fiscal year 2022.’’. 21 (b) CONFORMING AMENDMENTS.— 22 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 2713 IH (1) Section 1902(j) of the Social Security Act 1 (42 U.S.C. 1396a(j)) is amended by striking ‘‘, the 2 limitation in section 1108(f),’’. 3 (2) Section 1903(u) of the Social Security Act 4 (42 U.S.C. 1396b(u)) is amended by striking para- 5 graph (4). 6 (c) EFFECTIVE DATE.—The amendments made by 7 this section shall apply beginning with fiscal year 2022. 8 SEC. 102. ELIMINATION OF SPECIFIC FEDERAL MEDICAL 9 ASSISTANCE PERCENTAGE (FMAP) LIMITA- 10 TION FOR TERRITORIES; TEMPORARY IN- 11 CREASE IN FMAP FOR PUERTO RICO AND 12 THE VIRGIN ISLANDS TO 100 PERCENT. 13 Section 1905(b) of the Social Security Act (42 U.S.C. 14 1396d(b)) is amended— 15 (1) in clause (2), by inserting ‘‘for fiscal years 16 before fiscal year 2022’’ after ‘‘American Samoa’’; 17 and 18 (2) by adding at the end the following new sen- 19 tence: ‘‘Notwithstanding the first sentence of this 20 subsection, for each of fiscal years 2022 and 2023, 21 the Federal medical assistance percentage for Puerto 22 Rico and the Virgin Islands shall be 100 percent.’’. 23 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 2713 IH SEC. 103. APPLICATION OF MEDICAID WAIVER AUTHORITY 1 TO ALL OF THE TERRITORIES. 2 (a) IN GENERAL.—Section 1902(j) of the Social Se- 3 curity Act (42 U.S.C. 1396a(j)) is amended— 4 (1) by striking ‘‘American Samoa and the 5 Northern Mariana Islands’’ and inserting ‘‘Puerto 6 Rico, the Virgin Islands, Guam, the Northern Mar- 7 iana Islands, and American Samoa’’; 8 (2) by striking ‘‘American Samoa or the North- 9 ern Mariana Islands’’ and inserting ‘‘Puerto Rico, 10 the Virgin Islands, Guam, the Northern Mariana Is- 11 lands, or American Samoa’’; 12 (3) by inserting ‘‘(1)’’ before ‘‘Notwith- 13 standing’’; 14 (4) by inserting ‘‘except as otherwise provided 15 in this subsection,’’ after ‘‘Notwithstanding any 16 other requirement of this title’’; and 17 (5) by adding at the end the following: 18 ‘‘(2) The Secretary may not waive under this sub- 19 section— 20 ‘‘(A) the requirement of subsection 21 (a)(10)(A)(i)(IX) (relating to coverage of adults for- 22 merly under foster care) with respect to any terri- 23 tory; 24 ‘‘(B) the requirement to provide medical assist- 25 ance for early and periodic screening, diagnostic, 26 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 2713 IH and treatment services (as defined in section 1 1905(r)) for individuals who are eligible for assist- 2 ance under the program and who are under the age 3 of 21; or 4 ‘‘(C) the requirement to provide for payment 5 for services described in section 1905(a)(2)(C) fur- 6 nished by a Federally-qualified health center and 7 services described in section 1905(a)(2)(B) furnished 8 by a rural health clinic in accordance with the provi- 9 sions of subsection (bb).’’. 10 (b) EFFECTIVE DATE.—The amendments made by 11 this section shall apply beginning October 1, 2021. 12 SEC. 104. PERMITTING MEDICAID DSH ALLOTMENTS FOR 13 TERRITORIES. 14 Section 1923(f) of the Social Security Act (42 U.S.C. 15 1396r–4(f)) is amended— 16 (1) in paragraph (6), by adding at the end the 17 following new subparagraph: 18 ‘‘(C) TERRITORIES.— 19 ‘‘(i) FISCAL YEAR 2021.—For fiscal 20 year 2022, the DSH allotment for Puerto 21 Rico, the Virgin Islands, Guam, the North- 22 ern Mariana Islands, and American Samoa 23 shall bear the same ratio to $300,000,000 24 as the ratio of the number of individuals 25 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 2713 IH who are low-income or uninsured and re- 1 siding in such respective territory (as esti- 2 mated from time to time by the Secretary) 3 bears to the sums of the number of such 4 individuals residing in all of the territories. 5 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 6 For each subsequent fiscal year, the DSH 7 allotment for each such territory is subject 8 to an increase in accordance with para- 9 graph (3).’’; and 10 (2) in paragraph (9), by inserting before the pe- 11 riod at the end the following: ‘‘, and includes, begin- 12 ning with fiscal year 2022, Puerto Rico, the Virgin 13 Islands, Guam, the Northern Mariana Islands, and 14 American Samoa’’. 15 Subtitle B—Medicare Part A 16 SEC. 111. CALCULATION OF MEDICARE DSH PAYMENTS FOR 17 IPPS HOSPITALS IN PUERTO RICO. 18 Section 1886(d)(9)(D)(iii) of the Social Security Act 19 (42 U.S.C. 1395ww(d)(9)(D)(iii)) is amended to read as 20 follows: 21 ‘‘(iii) Subparagraph (F) (relating to dispropor- 22 tionate share payments), including application of 23 subsection (r), except that for this purpose— 24 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 2713 IH ‘‘(I) the sum described in clause (ii) of this 1 subparagraph shall be substituted for the sum 2 referred to in paragraph (5)(F)(ii)(I); and 3 ‘‘(II) for discharges occurring on or after 4 October 1, 2021, subclause (I) of paragraph 5 (5)(F)(vi) shall be applied by substituting for 6 the numerator described in such subclause the 7 number of subsection (d) Puerto Rico hospital’s 8 patient days for the cost reporting period in- 9 volved which were made up of patients who (for 10 such days) were entitled to benefits under part 11 A of this title and were— 12 ‘‘(aa) entitled to supplementary secu- 13 rity income benefits (excluding any State 14 supplementation) under title XVI of this 15 Act; 16 ‘‘(bb) eligible for medical assistance 17 under a State plan under title XIX; or 18 ‘‘(cc) receiving aid or assistance under 19 any plan of the State approved under title 20 I, X, XIV, or XVI.’’. 21 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 2713 IH SEC. 112. REBASING TARGET AMOUNT FOR HOSPITALS IN 1 TERRITORIES. 2 Section 1886(b)(3) of the Social Security Act (42 3 U.S.C. 1395ww(b)(3)) is amended by adding at the end 4 the following new subparagraph: 5 ‘‘(M)(i) For each cost reporting period beginning on 6 or after October 1, 2021, in the case of a hospital located 7 in a territory of the United States, there shall be sub- 8 stituted for the target amount otherwise determined under 9 subparagraph (A) the rebased target amount (as defined 10 in clause (ii)), if such substitution results in an amount 11 of payment under this section to the hospital for such pe- 12 riod that is greater than the amount of payment that 13 would be made under this section to the hospital for such 14 period if this subparagraph were not to apply. 15 ‘‘(ii) For purposes of this subparagraph, the term 16 ‘rebased target amount’ has the meaning given the term 17 ‘target amount’ in subparagraph (A), except that— 18 ‘‘(I) there shall be substituted for the preceding 19 12-month cost reporting period the 12-month cost 20 reporting period beginning during fiscal year 2017 21 (or, at the option of the hospital, beginning during 22 fiscal year 2019); 23 ‘‘(II) any reference in subparagraph (A)(i) to 24 the ‘first such cost reporting period’ is deemed a ref- 25 erence to the first cost reporting period following the 26 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 2713 IH 12-month cost reporting period beginning during fis- 1 cal year 2017 (or, at the option of the hospital, be- 2 ginning during fiscal year 2019); and 3 ‘‘(III) the applicable percentage increase shall 4 only be applied under subparagraph (B)(ii) for cost 5 reporting periods beginning on or after October 1, 6 2021. 7 ‘‘(iii) Nothing in this subparagraph shall affect any 8 pending request by a hospital for a new target amount 9 for any cost reporting period beginning during a fiscal 10 year before fiscal year 2022.’’. 11 SEC. 113. MEDICARE DSH TARGET ADJUSTMENT FOR HOS- 12 PITALS IN TERRITORIES. 13 Section 1886(b)(3) of the Social Security Act (42 14 U.S.C. 1395ww(b)(3)), as amended by section 112, is fur- 15 ther amended by adding at the end the following new sub- 16 paragraph: 17 ‘‘(N)(i) For each cost reporting period beginning on 18 or after October 1, 2020, in the case of a hospital that 19 is located in a territory of the United States other than 20 Puerto Rico and that would be a subsection (d) hospital 21 if it were located in one of the 50 States, the target 22 amount shall be increased by— 23 ‘‘(I) in the case that such hospital has a dis- 24 proportionate patient percentage of not less than 15 25 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 2713 IH percent and not greater than 40 percent, 10 percent; 1 and 2 ‘‘(II) in the case that such hospital has a dis- 3 proportionate patient percentage of greater than 40 4 percent, 10 percent plus 60 percent of the number 5 of percentage points by which such hospital’s dis- 6 proportionate patient percentage exceeds 40 percent. 7 ‘‘(ii) For purposes of this subparagraph, the term 8 ‘disproportionate patient percentage’ has the meaning 9 given such term in subsection (d)(5)(F)(vi), except that 10 in applying such meaning any reference under such sub- 11 section to individuals entitled to supplementary security 12 income under title XVI shall be deemed for purposes of 13 this subparagraph to include individuals— 14 ‘‘(I) eligible for medical assistance under a 15 State plan under title XIX; or 16 ‘‘(II) receiving aid or assistance under any plan 17 of the territory approved under title I, X, XIV, or 18 XVI.’’. 19 VerDate Sep 11 2014 23:20 Jun 10, 2021 Jkt 019 [Text truncated for display. 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