Territories Health Care Improvement Act

I 116TH CONGRESS 1ST SESSION H. R. 3631 To amend titles XI and XIX of the Social Security Act to provide for a temporary increase to the limit on Medicaid payments for territories of the United States and the Federal medical assistance percentage for such territories under the Medicaid program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JULY 9, 2019 Mr. SOTO (for himself, Mr. BILIRAKIS, Ms. VELA´ZQUEZ, Miss GONZA´LEZ- COLO´N of Puerto Rico, Ms. PLASKETT, Mr. SABLAN, Mrs. RADEWAGEN, Mr. SAN NICOLAS, Mr. SERRANO, and Mr. FITZPATRICK) introduced the following bill; which was referred to the Committee on Energy and Com- merce A BILL To amend titles XI and XIX of the Social Security Act to provide for a temporary increase to the limit on Med- icaid payments for territories of the United States and the Federal medical assistance percentage for such terri- tories under the Medicaid program, and for other pur- poses. 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 ‘‘Territories Health 4 Care Improvement Act’’. 5 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 3631 IH SEC. 2. MEDICAID PAYMENTS FOR PUERTO RICO AND THE 1 OTHER TERRITORIES FOR CERTAIN FISCAL 2 YEARS. 3 (a) TREATMENT OF CAP.—Section 1108(g) of the 4 Social Security Act (42 U.S.C. 1308(g)) is amended— 5 (1) in paragraph (2)— 6 (A) in the matter preceding subparagraph 7 (A), by striking ‘‘subject to and section 8 1323(a)(2) of the Patient Protection and Af- 9 fordable Care Act paragraphs (3) and (5)’’ and 10 inserting ‘‘subject to section 1323(a)(2) of the 11 Patient Protection and Affordable Care Act and 12 paragraphs (3) and (5)’’; 13 (B) in subparagraph (A)— 14 (i) by striking ‘‘Puerto Rico shall not 15 exceed the sum of’’ and inserting ‘‘Puerto 16 Rico shall not exceed— 17 ‘‘(i) except as provided in clause (ii), 18 the sum of’’; 19 (ii) by striking ‘‘$100,000;’’ and in- 20 serting ‘‘$100,000; and’’; and 21 (iii) by adding at the end the fol- 22 lowing new clause: 23 ‘‘(ii) for each of fiscal years 2020 24 through 2023, the amount specified in 25 paragraph (6) for each such fiscal year;’’; 26 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 3631 IH (C) in subparagraph (B)— 1 (i) by striking ‘‘the Virgin Islands 2 shall not exceed the sum of’’ and inserting 3 ‘‘the Virgin Islands shall not exceed— 4 ‘‘(i) except as provided in clause (ii), 5 the sum of’’; 6 (ii) by striking ‘‘$10,000;’’ and insert- 7 ing ‘‘$10,000; and’’; and 8 (iii) by adding at the end the fol- 9 lowing new clause: 10 ‘‘(ii) for each of fiscal years 2020 11 through 2025, $126,000,000;’’; 12 (D) in subparagraph (C)— 13 (i) by striking ‘‘Guam shall not exceed 14 the sum of’’ and inserting ‘‘Guam shall not 15 exceed— 16 ‘‘(i) except as provided in clause (ii), 17 the sum of’’; 18 (ii) by striking ‘‘$10,000;’’ and insert- 19 ing ‘‘$10,000; and’’; and 20 (iii) by adding at the end the fol- 21 lowing new clause: 22 ‘‘(ii) for each of fiscal years 2020 23 through 2025, $127,000,000;’’; 24 (E) in subparagraph (D)— 25 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 3631 IH (i) by striking ‘‘the Northern Mariana 1 Islands shall not exceed the sum of’’ and 2 inserting ‘‘the Northern Mariana Islands 3 shall not exceed— 4 ‘‘(i) except as provided in clause (ii), 5 the sum of’’; and 6 (ii) by adding at the end the following 7 new clause: 8 ‘‘(ii) for each of fiscal years 2020 9 through 2025, $60,000,000; and’’; and 10 (F) in subparagraph (E)— 11 (i) by striking ‘‘American Samoa shall 12 not exceed the sum of’’ and inserting 13 ‘‘American Samoa shall not exceed— 14 ‘‘(i) except as provided in clause (ii), 15 the sum of’’; 16 (ii) by striking ‘‘$10,000.’’ and insert- 17 ing ‘‘$10,000; and’’; and 18 (iii) by adding at the end the fol- 19 lowing new clause: 20 ‘‘(ii) for each of fiscal years 2020 21 through 2025, $84,000,000.’’; and 22 (2) by adding at the end the following new 23 paragraph: 24 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 3631 IH ‘‘(6) APPLICATION TO PUERTO RICO FOR FIS- 1 CAL YEARS 2020 THROUGH 2023.—For purposes of 2 paragraph (2)(A)(ii), the amount specified in this 3 paragraph is— 4 ‘‘(A) for fiscal year 2020, $2,823,188,000; 5 ‘‘(B) for fiscal year 2021, $2,919,072,000; 6 ‘‘(C) for fiscal year 2022, $3,012,610,000; 7 and 8 ‘‘(D) for fiscal year 2023, 9 $3,114,331,000.’’. 10 (b) TREATMENT OF FUNDING UNDER ENHANCED 11 ALLOTMENT PROGRAM.—Section 1935(e) of the Social 12 Security Act (42 U.S.C. 1396u–5(e)) is amended— 13 (1) in paragraph (1)(B), by striking ‘‘if the 14 State’’ and inserting ‘‘subject to paragraph (4), if 15 the State’’; 16 (2) by redesignating paragraph (4) as para- 17 graph (5); and 18 (3) by inserting after paragraph (3) the fol- 19 lowing new paragraph: 20 ‘‘(4) TREATMENT OF FUNDING FOR CERTAIN 21 FISCAL YEARS.— 22 ‘‘(A) PUERTO RICO.—Notwithstanding 23 paragraph (1)(B), in the case that Puerto Rico 24 establishes and submits to the Secretary a plan 25 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 3631 IH described in paragraph (2) with respect to any 1 of fiscal years 2020 through 2022, the amount 2 specified in paragraph (3) for Puerto Rico for 3 such a year shall be taken into account in ap- 4 plying subparagraph (A)(ii) of section 5 1108(g)(2) for such year. 6 ‘‘(B) OTHER TERRITORIES.—Notwith- 7 standing paragraph (1)(B), in the case that the 8 Virgin Islands, Guam, the Northern Mariana 9 Islands, or American Samoa establishes and 10 submits to the Secretary a plan described in 11 paragraph (2) with respect to any of fiscal 12 years 2020 through 2025, the amount specified 13 in paragraph (3) for the Virgin Islands, Guam, 14 the Northern Mariana Islands, or American 15 Samoa, as the case may be, shall be taken into 16 account in applying, as applicable, subpara- 17 graph (B)(ii), (C)(ii), (D)(ii), or (E)(ii) of sec- 18 tion 1108(g)(2) for such year.’’. 19 (c) INCREASED FMAP.—Section 1905 of the Social 20 Security Act (42 U.S.C. 1396d(b)) is amended— 21 (1) in subsection (b), by striking ‘‘and (aa)’’ 22 and inserting ‘‘(aa), and (ff)’’; and 23 (2) by adding at the end the following new sub- 24 section: 25 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 3631 IH ‘‘(ff) TEMPORARY INCREASE IN FMAP FOR TERRI- 1 TORIES FOR CERTAIN FISCAL YEARS.— 2 ‘‘(1) PUERTO RICO.—Notwithstanding sub- 3 section (b), the Federal medical assistance percent- 4 age for Puerto Rico shall be equal to— 5 ‘‘(A) 83 percent for fiscal years 2020 and 6 2021; and 7 ‘‘(B) 76 percent for fiscal years 2022 and 8 2023. 9 ‘‘(2) VIRGIN ISLANDS.—Notwithstanding sub- 10 section (b), the Federal medical assistance percent- 11 age for the Virgin Islands shall be equal to— 12 ‘‘(A) 100 percent for fiscal year 2020; 13 ‘‘(B) 83 percent for fiscal years 2021 14 through 2024; and 15 ‘‘(C) 76 percent for fiscal year 2025. 16 ‘‘(3) OTHER TERRITORIES.—Notwithstanding 17 subsection (b), the Federal medical assistance per- 18 centage for Guam, the Northern Mariana Islands, 19 and American Samoa shall be equal to— 20 ‘‘(A) 100 percent for fiscal years 2020 and 21 2021; 22 ‘‘(B) 83 percent for fiscal years 2022 23 through 2024; and 24 ‘‘(C) 76 percent for fiscal year 2025.’’. 25 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 3631 IH (d) ANNUAL REPORT.—Section 1108(g) of the Social 1 Security Act (42 U.S.C. 1308(g)), as amended by sub- 2 section (a), is further amended by adding at the end the 3 following new paragraph: 4 ‘‘(7) ANNUAL REPORT.— 5 ‘‘(A) IN GENERAL.—Not later than the 6 date that is 30 days after the end of each fiscal 7 year (beginning with fiscal year 2020 and end- 8 ing with fiscal year 2025), in the case that a 9 specified territory receives a Medicaid cap in- 10 crease, or an increase in the Federal medical 11 assistance percentage for such territory under 12 section 1905(ff), for such fiscal year, such terri- 13 tory shall submit to the Chair and Ranking 14 Member of the Committee on Energy and Com- 15 merce of the House of Representatives and the 16 Chair and Ranking Member of the Committee 17 on Finance of the Senate a report that de- 18 scribes how such territory has used such Med- 19 icaid cap increase, or such increase in the Fed- 20 eral medical assistance percentage, as applica- 21 ble, to increase access to health care under the 22 State Medicaid plan of such territory under title 23 XIX (or a waiver of such plan). Such report 24 may include— 25 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 3631 IH ‘‘(i) the extent to which such territory 1 has, with respect to such plan (or waiv- 2 er)— 3 ‘‘(I) increased payments to health 4 care providers; 5 ‘‘(II) increased covered benefits; 6 ‘‘(III) expanded health care pro- 7 vider networks; or 8 ‘‘(IV) improved in any other 9 manner the carrying out of such plan 10 (or waiver); and 11 ‘‘(ii) any other information as deter- 12 mined necessary by such territory. 13 ‘‘(B) DEFINITIONS.—In this paragraph: 14 ‘‘(i) MEDICAID CAP INCREASE.—The 15 term ‘Medicaid cap increase’ means, with 16 respect to a specified territory and fiscal 17 year, any increase in the amounts other- 18 wise determined under this subsection for 19 such territory for such fiscal year by rea- 20 son of the amendments made by section 21 2(a) of the Territories Health Care Im- 22 provement Act. 23 ‘‘(ii) SPECIFIED TERRITORY.—The 24 term ‘specified territory’ means Puerto 25 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 3631 IH Rico, the Virgin Islands, Guam, the North- 1 ern Mariana Islands, and American 2 Samoa.’’. 3 SEC. 3. APPLICATION OF CERTAIN REQUIREMENTS UNDER 4 MEDICAID PROGRAM TO CERTAIN TERRI- 5 TORIES. 6 (a) APPLICATION OF PAYMENT ERROR RATE MEAS- 7 UREMENT REQUIREMENTS TO PUERTO RICO.—Section 8 1903(u)(4) of the Social Security Act (42 U.S.C. 9 1396b(u)(4)) is amended— 10 (1) by striking ‘‘to Puerto Rico, Guam’’ and in- 11 serting ‘‘to Guam’’; and 12 (2) by striking ‘‘or American Samoa.’’ and in- 13 serting ‘‘or American Samoa, or, for fiscal years be- 14 fore fiscal year 2023, to Puerto Rico.’’. 15 (b) APPLICATION OF ASSET VERIFICATION PROGRAM 16 REQUIREMENTS TO PUERTO RICO AND VIRGIN IS- 17 LANDS.—Section 1940(a) of the Social Security Act (42 18 U.S.C. 1396w(a)) is amended— 19 (1) in paragraph (3)(A), by adding at the end 20 the following new clause: 21 ‘‘(iii) IMPLEMENTATION IN PUERTO 22 RICO AND VIRGIN ISLANDS.—The Sec- 23 retary shall require Puerto Rico to imple- 24 ment an asset verification program under 25 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 3631 IH this subsection by the end of fiscal year 1 2022 and the Virgin Islands to implement 2 such a program by the end of fiscal year 3 2023.’’; and 4 (2) in paragraph (4)— 5 (A) in the paragraph heading, by striking 6 ‘‘EXEMPTION OF TERRITORIES’’ and inserting 7 ‘‘EXEMPTION OF CERTAIN TERRITORIES’’; and 8 (B) by striking ‘‘and the District of Co- 9 lumbia’’ and inserting ‘‘, the District of Colum- 10 bia, Puerto Rico, and the Virgin Islands’’. 11 (c) APPLICATION OF CERTAIN DATA REPORTING 12 AND PROGRAM INTEGRITY REQUIREMENTS TO NORTH- 13 ERN MARIANA ISLANDS, AMERICAN SAMOA, AND GUAM.— 14 (1) IN GENERAL.—Section 1902 of the Social 15 Security Act (42 U.S.C. 1396a) is amended by add- 16 ing at the end the following new subsection: 17 ‘‘(qq) APPLICATION OF CERTAIN DATA REPORTING 18 AND PROGRAM INTEGRITY REQUIREMENTS TO NORTH- 19 ERN MARIANA ISLANDS, AMERICAN SAMOA, AND GUAM.— 20 Not later than October 1, 2023, the Northern Mariana 21 Islands, American Samoa, and Guam shall— 22 ‘‘(1) implement methods, satisfactory to the 23 Secretary, for the collection and reporting of reliable 24 data to the Transformed Medicaid Statistical Infor- 25 VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS 12 •HR 3631 IH mation System (T–MSIS) (or a successor system); 1 and 2 ‘‘(2) demonstrate progress in establishing a 3 State medicaid fraud control unit described in sec- 4 tion 1903(q).’’. 5 (2) CONFORMING AMENDMENT.—Section 6 1902(j) of the Social Security Act (42 U.S.C. 7 1396a(j)) is amended— 8 (A) by striking ‘‘or the requirement’’ and 9 inserting ‘‘, the requirement’’; and 10 (B) by inserting before the period at the 11 end the following: ‘‘, or the requirements under 12 subsection (qq) (relating to data reporting and 13 program integrity)’’. 14 Æ VerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\H3631.IH H3631 pamtmann on DSKBFK8HB2PROD with BILLS