Permanent Relief for Seniors and Medicare, Medicaid, Human Services Extension Act of 2019

II 116TH CONGRESS 1ST SESSION S. 3001 To provide for certain extensions with respect to the Medicare and Medicaid programs under titles XVIII and XIX of the Social Security Act, and for other purposes. IN THE SENATE OF THE UNITED STATES DECEMBER 9, 2019 Mr. TOOMEY (for himself and Mr. CRAPO) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To provide for certain extensions with respect to the Medi- care and Medicaid programs under titles XVIII and XIX of the Social Security Act, 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 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Permanent Relief for Seniors and Medicare, Medicaid, 5 Human Services Extension Act of 2019’’. 6 (b) TABLE OF CONTENTS.—The table of contents for 7 this Act is as follows: 8 Sec. 1. Short title; table of contents. VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 3001 IS TITLE I—MISCELLANEOUS Sec. 101. Repeal of medical device excise tax. Sec. 102. Permanent extension of reduction in medical expense deduction floor. Sec. 103. Moratorium on annual fee on health insurance providers. TITLE II—MEDICARE EXTENDERS Sec. 201. Extension of the work geographic index floor under the Medicare pro- gram. Sec. 202. Authorization of additional funding for quality measure endorsement, input, and selection. Sec. 203. Authorization of additional funding for outreach and assistance for low-income programs. Sec. 204. Extension and authorization of additional funding to the Patient-Cen- tered Outcomes Research Trust Fund. TITLE III—MEDICAID EXTENDERS Sec. 301. Delay of DSH reductions. Sec. 302. Extension of spousal impoverishment protections. Sec. 303. Extension of Community Mental Health Services demonstration pro- gram. TITLE IV—HUMAN SERVICES EXTENDERS Sec. 401. Extension of sexual risk avoidance education program. Sec. 402. Jobs and Opportunity with Benefits and Services for Success Act. TITLE I—MISCELLANEOUS 1 SEC. 101. REPEAL OF MEDICAL DEVICE EXCISE TAX. 2 (a) IN GENERAL.—Chapter 32 of the Internal Rev- 3 enue Code of 1986 is amended by striking subchapter E. 4 (b) CONFORMING AMENDMENTS.— 5 (1) Subsection (a) of section 4221 of the Inter- 6 nal Revenue Code of 1986 is amended by striking 7 the last sentence. 8 (2) Paragraph (2) of section 6416(b) of such 9 Code is amended by striking the last sentence. 10 (c) CLERICAL AMENDMENT.—The table of sub- 11 chapters for chapter 32 of the Internal Revenue Code of 12 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 3001 IS 1986 is amended by striking the item relating to sub- 1 chapter E. 2 (d) EFFECTIVE DATE.—The amendments made by 3 this section shall apply to sales after December 31, 2019. 4 SEC. 102. PERMANENT EXTENSION OF REDUCTION IN MED- 5 ICAL EXPENSE DEDUCTION FLOOR. 6 (a) REDUCTION.— 7 (1) IN GENERAL.—Section 213(a) of the Inter- 8 nal Revenue Code of 1986 is amended by striking 9 ‘‘10 percent’’ and inserting ‘‘7.5 percent’’. 10 (2) CONFORMING AMENDMENT.—Section 213 11 of such Code is amended by striking subsection (f). 12 (b) REPEAL OF MINIMUM TAX PREFERENCE.—Sec- 13 tion 56(b)(1) of the Internal Revenue Code of 1986 is 14 amended by striking subparagraph (B). 15 (c) EFFECTIVE DATE.—The amendments made by 16 this section shall apply to taxable years beginning after 17 December 31, 2018. 18 SEC. 103. MORATORIUM ON ANNUAL FEE ON HEALTH IN- 19 SURANCE PROVIDERS. 20 Subsection (j) of section 9010 of the Patient Protec- 21 tion and Affordable Care Act (26 U.S.C. 4001 note prec.) 22 is amended— 23 (1) by striking ‘‘and’’ at the end of paragraph 24 (2); 25 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 3001 IS (2) by striking the period at the end of para- 1 graph (3) and inserting ‘‘, and ending before Janu- 2 ary 1, 2021, and’’; and 3 (3) by adding at the end the following new 4 paragraph: 5 ‘‘(4) beginning after December 31, 2022.’’. 6 TITLE II—MEDICARE 7 EXTENDERS 8 SEC. 201. EXTENSION OF THE WORK GEOGRAPHIC INDEX 9 FLOOR UNDER THE MEDICARE PROGRAM. 10 Section 1848(e)(1)(E) of the Social Security Act (42 11 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu- 12 ary 1, 2020’’ and inserting ‘‘December 21, 2020’’. 13 SEC. 202. AUTHORIZATION OF ADDITIONAL FUNDING FOR 14 QUALITY MEASURE ENDORSEMENT, INPUT, 15 AND SELECTION. 16 Section 1890(d)(2) of the Social Security Act (42 17 U.S.C. 1395aaa(d)(2)) is amended— 18 (1) by inserting ‘‘(A)’’ after ‘‘(2)’’; and 19 (2) by adding at the end the following new sub- 20 paragraph: 21 ‘‘(B)(i) For purposes of carrying out this section and 22 section 1890A (other than subsections (e) and (f)), there 23 is hereby authorized to be appropriated for the period be- 24 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 3001 IS ginning on December 21, 2019, and ending on December 1 20, 2020, $30,000,000. 2 ‘‘(ii) Amounts appropriated pursuant to clause (i) 3 shall remain available until expended, and shall be in addi- 4 tion to any unobligated funds transferred pursuant to sub- 5 paragraph (A) for a preceding fiscal year that are avail- 6 able under the third sentence of such subparagraph.’’. 7 SEC. 203. AUTHORIZATION OF ADDITIONAL FUNDING FOR 8 OUTREACH AND ASSISTANCE FOR LOW-IN- 9 COME PROGRAMS. 10 (a) ADDITIONAL FUNDING FOR STATE HEALTH IN- 11 SURANCE PROGRAMS.—Subsection (a)(1)(B) of section 12 119 of the Medicare Improvements for Patients and Pro- 13 viders Act of 2008 (42 U.S.C. 1395b–3 note), as amended 14 by section 3306 of the Patient Protection and Affordable 15 Care Act (Public Law 111–148), section 610 of the Amer- 16 ican Taxpayer Relief Act of 2012 (Public Law 112–240), 17 section 1110 of the Pathway for SGR Reform Act of 2013 18 (Public Law 113–67), section 110 of the Protecting Ac- 19 cess to Medicare Act of 2014 (Public Law 113–93), sec- 20 tion 208 of the Medicare Access and CHIP Reauthoriza- 21 tion Act of 2015 (Public Law 114–10), section 50207 of 22 division E of the Bipartisan Budget Act of 2018 (Public 23 Law 115–123), section 1402 of the Continuing Appropria- 24 tions Act, 2020, and Health Extenders Act of 2019 (Pub- 25 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 3001 IS lic Law 116–59), and section 1402 of the Further Con- 1 tinuing Appropriations Act, 2020, and Further Health 2 Extenders Act of 2019 (Public Law 116–69), is amend- 3 ed— 4 (1) by redesignating clauses (i) through (xi) as 5 subclauses (I) through (XI) and moving such sub- 6 clauses 2 ems to the right; 7 (2) by striking ‘‘For purposes of making grants 8 under this subsection, the Secretary’’ and inserting 9 ‘‘For purposes of making grants under this sub- 10 section— 11 ‘‘(i) the Secretary’’; 12 (3) in subclause (XI), as redesignated by para- 13 graph (1), by striking the period at the end and in- 14 serting ‘‘; and’’; and 15 (4) by inserting after such subclause (XI), the 16 following new clause: 17 ‘‘(ii) there is hereby authorized to be 18 appropriated for the period beginning on 19 December 21, 2019, and ending on Decem- 20 ber 20, 2020, $13,000,000.’’. 21 (b) ADDITIONAL FUNDING FOR AREA AGENCIES ON 22 AGING.—Subsection (b)(1)(B) of such section 119, as so 23 amended, is amended— 24 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 3001 IS (1) by redesignating clauses (i) through (xi) as 1 subclauses (I) through (XI) and moving such sub- 2 clauses 2 ems to the right; 3 (2) by striking ‘‘For purposes of making grants 4 under this subsection, the Secretary’’ and inserting 5 ‘‘For purposes of making grants under this sub- 6 section— 7 ‘‘(i) the Secretary’’; 8 (3) in subclause (XI), as redesignated by para- 9 graph (1), by striking the period at the end and in- 10 serting ‘‘; and’’; and 11 (4) by inserting after such subclause (XI), the 12 following new clause: 13 ‘‘(ii) there is hereby authorized to be 14 appropriated for the period beginning on 15 December 21, 2019, and ending on Decem- 16 ber 20, 2020, $7,500,000.’’. 17 (c) ADDITIONAL FUNDING FOR AGING AND DIS- 18 ABILITY RESOURCE CENTERS.—Subsection (c)(1)(B) of 19 such section 119, as so amended, is amended— 20 (1) by redesignating clauses (i) through (xi) as 21 subclauses (I) through (XI) and moving such sub- 22 clauses 2 ems to the right; 23 (2) by striking ‘‘For purposes of making grants 24 under this subsection, the Secretary’’ and inserting 25 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 3001 IS ‘‘For purposes of making grants under this sub- 1 section— 2 ‘‘(i) the Secretary’’; 3 (3) in subclause (XI), as redesignated by para- 4 graph (1), by striking the period at the end and in- 5 serting ‘‘; and’’; and 6 (4) by inserting after such subclause (XI), the 7 following new clause: 8 ‘‘(ii) there is hereby authorized to be 9 appropriated for the period beginning on 10 December 21, 2019, and ending on Decem- 11 ber 20, 2020, $5,000,000.’’. 12 (d) ADDITIONAL FUNDING FOR CONTRACT WITH 13 THE NATIONAL CENTER FOR BENEFITS AND OUTREACH 14 ENROLLMENT.—Subsection (d)(2) of such section 119, as 15 so amended, is amended— 16 (1) by redesignating clauses (i) through (xi) as 17 subclauses (I) through (XI) and moving such sub- 18 clauses 2 ems to the right; 19 (2) by striking ‘‘For purposes of making a 20 grant or entering into a contract under paragraph 21 (1), the Secretary’’ and inserting ‘‘For purposes of 22 making a grant or entering into a contract under 23 paragraph (1)— 24 ‘‘(i) the Secretary’’; 25 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 3001 IS (3) in subclause (XI), as redesignated by para- 1 graph (1), by striking the period at the end and in- 2 serting ‘‘; and’’; and 3 (4) by inserting after such subclause (XI), the 4 following new clause: 5 ‘‘(ii) there is hereby authorized to be 6 appropriated for the period beginning on 7 December 21, 2019, and ending on Decem- 8 ber 20, 2020, $12,000,000.’’. 9 SEC. 204. EXTENSION AND AUTHORIZATION OF ADDI- 10 TIONAL FUNDING TO THE PATIENT-CEN- 11 TERED OUTCOMES RESEARCH TRUST FUND. 12 Section 9511 of the Internal Revenue Code of 1986 13 is amended— 14 (1) in subsection (b), by adding at the end the 15 following new paragraph: 16 ‘‘(4) AUTHORIZATION.— 17 ‘‘(A) IN GENERAL.—There is hereby au- 18 thorized to be appropriated to the Trust Fund, 19 for the period beginning on October 1, 2019, 20 and ending on December 20, 2020, an amount 21 equal to the sum of— 22 ‘‘(i) an amount equal to $2 multiplied 23 by the average number of individuals enti- 24 tled to benefits under part A, or enrolled 25 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 3001 IS under part B, of title XVIII of the Social 1 Security Act during such period; and 2 ‘‘(ii) $150,000,000. 3 ‘‘(B) AVAILABILITY.—Amounts appro- 4 priated pursuant to subparagraph (A) shall re- 5 main available until expended.’’; 6 (2) in subsection (d)(2)(A), by inserting ‘‘, and 7 for the period beginning on October 1, 2019, and 8 ending on December 20, 2020,’’ after ‘‘2019’’; and 9 (3) in subsection (f), by striking ‘‘December 20, 10 2019’’ and inserting ‘‘December 20, 2020’’. 11 TITLE III—MEDICAID 12 EXTENDERS 13 SEC. 301. DELAY OF DSH REDUCTIONS. 14 Section 1923(f)(7)(A) of the Social Security Act (42 15 U.S.C. 1396r–4(f)(7)(A)) is amended— 16 (1) in clause (i), in the matter preceding sub- 17 clause (I), by striking ‘‘For the period beginning’’ 18 and all that follows through ‘‘2025’’ and inserting 19 ‘‘For the period beginning December 21, 2020, and 20 ending September 30, 2021, and for each of fiscal 21 years 2022 through 2028’’; and 22 (2) in clause (ii)— 23 (A) by amending subclause (I) to read as 24 follows: 25 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 3001 IS ‘‘(I) $8,000,000,000 for the pe- 1 riod beginning December 21, 2020, 2 and ending September 30, 2021; 3 and’’; and 4 (B) in subclause (II), by striking ‘‘fiscal 5 years 2021 through 2025’’ and inserting ‘‘fiscal 6 years 2022 through 2028’’. 7 SEC. 302. EXTENSION OF SPOUSAL IMPOVERISHMENT PRO- 8 TECTIONS. 9 (a) IN GENERAL.—Section 2404 of Public Law 111– 10 148 (42 U.S.C. 1396r–5 note) is amended by striking 11 ‘‘December 31, 2019’’ and inserting ‘‘December 20, 12 2020’’. 13 (b) RULE OF CONSTRUCTION.—Nothing in section 14 2404 of Public Law 111–148 (42 U.S.C. 1396r–5 note) 15 or section 1902(a)(17) or 1924 of the Social Security Act 16 (42 U.S.C. 1396a(a)(17), 1396r–5) shall be construed as 17 prohibiting a State from applying an income or resource 18 disregard under a methodology authorized under section 19 1902(r)(2) of such Act (42 U.S.C. 1396a(r)(2))— 20 (1) to the income or resources of an individual 21 described in section 1902(a)(10)(A)(ii)(VI) of such 22 Act (42 U.S.C. 1396a(a)(10)(A)(ii)(VI)) (including 23 a disregard of the income or resources of such indi- 24 vidual’s spouse); or 25 VerDate Sep 11 2014 18:36 Dec 14, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3001.IS S3001 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 3001 IS (2) on the basis of an individual’s need for 1 home and community-based services authorized 2 under subsection (c), (d), (i), or (k) of section 1915 3 of such Act (42 U.S.C. 1396n) or under section 4 1115 of such Act (42 U.S.C. 1315). 5 (c) GAO REPORT.—Not later than September 30, 6 2020, the Comptroller General of the United States shall 7 submit to Congress a report evaluating the effect of apply- 8 ing section 1924(h) of the Social Security Act (42 U.S.C. 9 1396r–5(h)) pursuant to section 2404 of Public Law 111– 10 148 (42 U.S.C. 1396r–5 note) on the number of individ- 11 uals who qualify as community spouses (as such term is 12 defined in such section 1924(h)). 13 SEC. 303. EXTENSION OF COMMUNITY MENTAL HEALTH 14 SERVICES DEMONSTRATION [Text truncated for display. Full text available on Congress.gov.]