Coronavirus Medicaid Response Act

I 116TH CONGRESS 2D SESSION H. R. 6539 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 APRIL 17, 2020 Mrs. LEE of Nevada introduced 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Coronavirus Medicaid 4 Response Act’’. 5 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6539 IH SEC. 2. INCREASING FEDERAL SUPPORT TO STATE MED- 1 ICAID PROGRAMS DURING ECONOMIC 2 DOWNTURNS. 3 (a) IN GENERAL.—Section 1905 of the Social Secu- 4 rity Act (42 U.S.C. 1396d) is amended— 5 (1) in subsection (b), by striking ‘‘and (ff)’’ and 6 inserting ‘‘(ff), and (gg)’’; and 7 (2) by adding at the end the following new sub- 8 section: 9 ‘‘(gg) INCREASED FMAP DURING ECONOMIC 10 DOWNTURNS.— 11 ‘‘(1) IN GENERAL.—Notwithstanding subsection 12 (b), (y), or (z)(2), if a fiscal quarter that begins on 13 or after January 1, 2020, is an economic downturn 14 quarter (as defined in paragraph (2)) with respect to 15 a State, then the Federal medical assistance percent- 16 age applicable to amounts expended by the State for 17 medical assistance for services furnished during such 18 quarter shall be increased in accordance with para- 19 graphs (3) and (4). 20 ‘‘(2) ECONOMIC DOWNTURN QUARTER.— 21 ‘‘(A) IN GENERAL.— 22 ‘‘(i) IN GENERAL.—In this subsection, 23 the term ‘economic downturn quarter’ 24 means, with respect to a State, a fiscal 25 quarter during which the State’s unem- 26 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6539 IH ployment rate for the quarter exceeds the 1 percentage determined for the State and 2 quarter under clause (ii). 3 ‘‘(ii) THRESHOLD PERCENTAGE.—The 4 percentage determined under this clause 5 for a State and fiscal quarter is the per- 6 centage equal to the lower of— 7 ‘‘(I) the State unemployment 8 rate at the 20th percentile of the dis- 9 tribution of the State’s quarterly un- 10 employment rates for the 60-quarter 11 period preceding the quarter involved, 12 increased by 1 percentage point; and 13 ‘‘(II) the State’s average quar- 14 terly unemployment rate for the 12- 15 quarter period preceding the quarter 16 involved, increased by 1 percentage 17 point. 18 ‘‘(B) UNEMPLOYMENT DATA.— 19 ‘‘(i) IN GENERAL.—Except as pro- 20 vided in clause (ii), for purposes of deter- 21 mining unemployment rates for a State 22 and a quarter under this paragraph, the 23 Secretary shall use data from the Local 24 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6539 IH Area Unemployment Statistics from the 1 Bureau of Labor Statistics. 2 ‘‘(ii) APPLICATION TO CERTAIN TER- 3 RITORIES.—In the case of the Virgin Is- 4 lands, Guam, the Northern Mariana Is- 5 lands, or American Samoa, the Secretary 6 shall use data from the U–6 unemployment 7 measure of the Bureau of Labor Statistics 8 to make any necessary determinations 9 under subparagraph (A). 10 ‘‘(3) FMAP INCREASE DURING ECONOMIC 11 DOWNTURN QUARTER.— 12 ‘‘(A) IN GENERAL.—During a fiscal quar- 13 ter that is an economic downturn quarter with 14 respect to a State, the Federal medical assist- 15 ance percentage otherwise determined for the 16 State and quarter under subsection (b) and, if 17 applicable, the Federal medical assistance per- 18 centage applicable under subsection (y), (z)(2), 19 or (ff) with respect to medical assistance fur- 20 nished by the State during such quarter to indi- 21 viduals described in either such subsection shall 22 be increased by the number of percentage 23 points (rounded to the nearest tenth of a per- 24 centage point) equal to the product of— 25 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 6539 IH ‘‘(i) the number of percentage points 1 (rounded to the nearest tenth of a percent- 2 age point) by which the unemployment 3 rate for the State and quarter exceeds the 4 percentage determined for the State and 5 quarter under paragraph (2)(A)(ii); and 6 ‘‘(ii) 4.8. 7 ‘‘(B) APPLICATION OF COVID–19 FMAP IN- 8 CREASE.—Any increase applicable to the Fed- 9 eral medical assistance percentage of a State 10 for a fiscal quarter under subparagraph (A) 11 shall be in addition to any increase to such per- 12 centage for such quarter made pursuant to sec- 13 tion 6008(a) of the Families First Coronavirus 14 Response Act. 15 ‘‘(C) LIMITATION.—In no case shall an in- 16 crease to the Federal medical assistance per- 17 centage of a State under this paragraph result 18 in a Federal medical assistance percentage that 19 exceeds 95 percent. 20 ‘‘(D) SCOPE OF APPLICATION.—Any in- 21 crease to the Federal medical assistance per- 22 centage of a State for a fiscal quarter under 23 this paragraph shall only apply with respect to 24 payments for amounts expended by the State 25 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 6539 IH for medical assistance for services furnished 1 during such quarter and shall not apply with 2 respect to— 3 ‘‘(i) disproportionate share hospital 4 payments described in section 1923; 5 ‘‘(ii) payments under title IV or XXI; 6 ‘‘(iii) any payments under this title 7 that are based on the enhanced FMAP de- 8 scribed in section 2105(b); or 9 ‘‘(iv) any payments under this title 10 that are based on a Federal medical assist- 11 ance percentage determined for a State 12 under subsection (aa) (but only to the ex- 13 tent that such Federal medical assistance 14 percentage is higher than the economic re- 15 covery FMAP). 16 ‘‘(4) ADVANCE PAYMENT; RETROSPECTIVE AD- 17 JUSTMENT.— 18 ‘‘(A) IN GENERAL.—Prior to the beginning 19 of each fiscal quarter that begins on or after 20 July 1, 2020, the Secretary shall, with respect 21 to each State— 22 ‘‘(i) determine the increase (if any) 23 that is expected to apply to the Federal 24 medical assistance percentage of such 25 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 6539 IH State for such quarter under this sub- 1 section based on the projections made for 2 the State and quarter under subparagraph 3 (B); and 4 ‘‘(ii) shall apply such increase to the 5 Federal medical assistance percentage of 6 the State for purposes of making payments 7 to the State for amounts expended during 8 such quarter as medical assistance under 9 the State plan. 10 ‘‘(B) PROJECTION OF STATE UNEMPLOY- 11 MENT RATES.—Prior to the beginning of each 12 fiscal quarter that begins on or after July 1, 13 2020, the Secretary, acting through the Chief 14 Actuary of the Centers for Medicare & Medicaid 15 Services, shall, using the most recently available 16 data described in paragraph (2)(B), make pro- 17 jections with respect to— 18 ‘‘(i) the unemployment rates for each 19 State for such quarter; 20 ‘‘(ii) the threshold percentages de- 21 scribed in paragraph (2)(A)(ii) for each 22 State for such quarter; and 23 ‘‘(iii) the national unemployment rate 24 for such quarter. 25 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 6539 IH ‘‘(C) RETROSPECTIVE ADJUSTMENT.—As 1 soon as practicable after final unemployment 2 data becomes available for a fiscal quarter that 3 begins on or after July 1, 2020, the Secretary 4 shall, with respect to each State— 5 ‘‘(i) make a final determination of the 6 increase (if any) applicable to the Federal 7 medical assistance percentage of the State 8 for the quarter under this subsection; and 9 ‘‘(ii) in accordance with subsection 10 (d)(2) of section 1903, reduce or increase 11 the amount payable to the State under 12 subsection (a) of such section for a subse- 13 quent fiscal quarter to the extent of any 14 overpayment or underpayment which the 15 Secretary determines was made as a result 16 of a miscalculation of the increase applica- 17 ble to the Federal medical assistance per- 18 centage of the State for such prior fiscal 19 quarter under this subsection. 20 ‘‘(5) RETROSPECTIVE APPLICATION OF OVER- 21 THE-LIMIT FMAP INCREASES.— 22 ‘‘(A) IN GENERAL.—If a State has excess 23 percentage points with respect to an economic 24 downturn quarter and an applicable FMAP (as 25 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 6539 IH determined under subparagraph (B)), the State 1 may elect to apply such excess percentage 2 points to increase such applicable FMAP for 3 one or more quarters during the look-back pe- 4 riod for the State and economic downturn quar- 5 ter in accordance with this paragraph. 6 ‘‘(B) EXCESS PERCENTAGE POINTS.—For 7 purposes of this paragraph, the number of ex- 8 cess percentage points for a State, economic 9 downturn quarter, and an applicable FMAP 10 shall be equal to the number of percentage 11 points by which— 12 ‘‘(i) the applicable FMAP for the 13 State and quarter (after application of 14 paragraph (3) but without regard to sub- 15 paragraph (C) of such paragraph); exceeds 16 ‘‘(ii) 95 percent. 17 ‘‘(C) EFFECT OF APPLICATION OF EXCESS 18 PERCENTAGE POINTS.—If a State elects to 19 apply excess percentage points to an applicable 20 FMAP to a quarter during a look-back period 21 under this paragraph, the Secretary shall deter- 22 mine the additional amount of payment under 23 section 1903(a) to which the State would have 24 been entitled for such quarter if the applicable 25 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 6539 IH FMAP (as so increased) had been in effect for 1 such quarter, and shall treat such additional 2 amount as an underpayment for such quarter. 3 ‘‘(D) DISTRIBUTION OF EXCESS PERCENT- 4 AGE POINTS.—A State that has excess percent- 5 age points with respect to an economic down- 6 turn quarter and applicable FMAP may elect to 7 divide such points among more than 1 quarter 8 during the look-back period for such State and 9 quarter provided that no excess percentage 10 point (or fraction of an excess percentage point) 11 is applied to the applicable FMAP of more than 12 1 quarter. 13 ‘‘(E) LIMITATIONS.— 14 ‘‘(i) NO INCREASES OVER 100 PER- 15 CENT.—A State may not increase an appli- 16 cable FMAP for any quarter during a look- 17 back period under this paragraph if such 18 increase would result in the applicable 19 FMAP for such quarter exceeding 100 per- 20 cent. 21 ‘‘(ii) SCOPE OF APPLICATION.—Any 22 increase to an applicable FMAP of a State 23 for a fiscal quarter under this paragraph— 24 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 6539 IH ‘‘(I) shall only apply with respect 1 to payments for amounts expended by 2 the State for medical assistance for 3 services furnished during such quarter 4 to which such applicable FMAP is ap- 5 plicable; and 6 ‘‘(II) shall not apply with respect 7 to payments described in paragraph 8 (3)(D). 9 ‘‘(F) DEFINITIONS.—In this paragraph: 10 ‘‘(i) APPLICABLE FMAP.—The term 11 ‘applicable FMAP’ means, with respect to 12 a State and fiscal quarter— 13 ‘‘(I) the Federal medical assist- 14 ance percentage determined for the 15 State and quarter under subsection 16 (b); 17 ‘‘(II) the Federal medical assist- 18 ance percentage applicable under sub- 19 section (y); 20 ‘‘(III) the Federal medical assist- 21 ance percentage applicable under sub- 22 section (z)(2); or 23 ‘‘(IV) the Federal medical assist- 24 ance percentage determined for the 25 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 6539 IH State and quarter under subsection 1 (ff). 2 ‘‘(ii) LOOK-BACK PERIOD.—The term 3 ‘look-back period’ means, with respect to a 4 State and a fiscal quarter that is an eco- 5 nomic downturn quarter for the State, the 6 period of 4 fiscal quarters that ends with 7 the fourth quarter which precedes the most 8 recent fiscal quarters that was not an eco- 9 nomic downturn quarter for the State. 10 ‘‘(6) REQUIREMENT FOR ALL STATES.—A State 11 may not receive an increase in the Federal medical 12 assistance percentage for such State under this sub- 13 section, with respect to a fiscal quarter, if— 14 ‘‘(A) eligibility standards, methodologies, 15 or procedures under the State plan or a waiver 16 of such plan are more restrictive during such 17 quarter than the eligibility standards, meth- 18 odologies, or procedures, respectively, under 19 such plan (or waiver) as in effect on the last 20 day of the most recent fiscal quarter that was 21 not an economic downturn quarter for the 22 State; 23 ‘‘(B) the amount of any premium imposed 24 by the State pursuant to section 1916 or 1916A 25 VerDate Sep 11 2014 18:39 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H6539.IH H6539 pamtmann on DSKBC07HB2PROD with BILLS 13 •HR 6539 IH during such quarter, with respect to an indi- 1 vidual enrolled under such plan (or waiver), ex- 2 ceeds the amount of such premium as of the 3 date described in subparagraph (A); or 4 ‘‘(C) the State fails to provide that an in- 5 dividual who is enrolled for benefits under such 6 plan (or waiver) as of the date described in sub- 7 paragraph (A) or enrolls for benefits under 8 such plan (or waiver) during the period begin- 9 ning with such date and ending with the day 10 before the first day of the next quarter that is 11 not an economic downturn quarter for the State 12 shall be treated as eligible for such benefits for 13 not less than 12 months (or, if such period is 14 less than 12 months, throughout such period) 15 unless the individual requests a voluntary ter- 16 mination of eligibility or the ind [Text truncated for display. 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