[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 2833 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 2833
To provide adjusted Federal medical assistance percentage rates during
a transitional assistance period.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 3, 2009
Mr. Reed (for himself, Mr. Brown, Mr. Whitehouse, Mr. Akaka, Mr.
Durbin, Ms. Klobuchar, and Mr. Begich) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide adjusted Federal medical assistance percentage rates during
a transitional assistance period.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Transitional Federal Medical
Assistance Percentage Act''.
SEC. 2. EXTENSION OF ARRA INCREASE IN FMAP.
Section 5001 of ARRA is amended--
(1) in subsection (a)(3), by striking ``first calendar
quarter'' and inserting ``first 3 calendar quarters'';
(2) in subsection (b)(2), by inserting before the period at
the end the following: ``and such paragraph shall not apply to
calendar quarters beginning on or after October 1, 2010'';
(3) in subsection (d), by inserting ``ending before October
1, 2010'' after ``entire fiscal years'' and after ``with
respect to fiscal years'';
(4) in subsection (g)(1), by striking ``September 30,
2011'' and inserting ``December 31, 2011''; and
(5) in subsection (h)(3), by striking ``December 31, 2010''
and inserting ``June 30, 2011''.
SEC. 3. ARRA TRANSITIONAL ASSISTANCE PERIOD.
For each fiscal quarter occurring during the period beginning on
July 1, 2011, and ending on December 31, 2013 (referred to in this Act
as the ``ARRA transitional assistance period''), a State's FMAP shall
be equal to the sum of--
(1) the adjusted base FMAP (as determined under section
4(a)(1));
(2) the general FMAP adjustment (as determined under
section 4(a)(2)); and
(3) the unemployment FMAP adjustment (as determined under
section 4(a)(3)).
SEC. 4. ADJUSTMENTS TO FEDERAL MEDICAL ASSISTANCE PERCENTAGE.
(a) Determination of Adjusted FMAP.--
(1) Adjusted base fmap.--
(A) In general.--Subject to subparagraph (B), the
adjusted base FMAP is determined as follows:
(i) For the fourth quarter of fiscal year
2011, the FMAP that would have applied to the
State under section 5001(a) of ARRA (assuming
that such section applied) for such fiscal
quarter minus 2 percentage points.
(ii) For any subsequent fiscal quarter
occurring during the ARRA transitional
assistance period, the FMAP as determined under
this paragraph for the preceding fiscal quarter
minus 2 percentage points.
(B) Elimination of negative adjustment.--If the
adjusted base FMAP applicable to a State under this
paragraph for any fiscal quarter occurring during the
ARRA transitional assistance period would be less than
the FMAP determined for the State for such quarter
without regard to this paragraph, this paragraph shall
not apply to such State.
(2) General fmap adjustment.--The general FMAP adjustment
shall be equal to the following:
(A) For the fourth quarter of fiscal year 2011, 5.7
percentage points.
(B) For the first quarter of fiscal year 2012, 4.95
percentage points.
(C) For the second quarter of fiscal year 2012,
3.95 percentage points.
(D) For the third quarter of fiscal year 2012, 2.7
percentage points.
(E) For the fourth quarter of fiscal year 2012, 1.2
percentage points.
(F) For any subsequent fiscal quarter occurring
during the ARRA transitional assistance period, 0.2
percentage points.
(3) Unemployment fmap adjustment.--
(A) In general.--Subject to subparagraphs (C) and
(D), the unemployment FMAP adjustment shall be equal to
the increase in the State's FMAP that would have
applied to the State under section 5001(c) of ARRA
(assuming that such section applied) for such fiscal
quarter minus the applicable reduction amount (as
described under subparagraph (B)).
(B) Applicable reduction amount.--For purposes of
subparagraph (A), the applicable reduction amount shall
be equal to the following:
(i) For the fourth fiscal quarter of fiscal
year 2011, 0.20 percentage points.
(ii) For any subsequent fiscal quarter
occurring during the ARRA transitional
assistance period, the sum of--
(I) the applicable reduction amount
for the preceding fiscal quarter; and
(II) 0.05 percentage points.
(C) Elimination of negative adjustment.--If the
unemployment FMAP adjustment applicable to a State
under this paragraph for any fiscal quarter during the
ARRA transitional assistance period would be less than
zero, this paragraph shall not apply to such State.
(D) Special rule.--
(i) In general.--For purposes of
subparagraph (A), with respect to the
computation of the state unemployment increase
percentage (as described under section
5001(c)(4) of ARRA) for the last 2 fiscal
quarters of the ARRA transitional assistance
period, the most recent previous 3-consecutive-
month period (as described under section
5001(c)(4)(A)(i) of ARRA) shall be the 3-
consecutive-month period beginning with
December 2012, or, if it results in a higher
applicable percent under section 5001(c)(3) of
ARRA, the 3-consecutive-month period beginning
with January 2013.
(ii) Repeal of special rule under arra for
last 2 calendar quarters of the recession
adjustment period.--Section 5001(c)(4) of ARRA
is amended by striking subparagraph (C) and
inserting the following:
``(C) Special rule.--With respect to the first 2
calendar quarters of the recession adjustment period,
the most recent previous 3-consecutive-month period
described in subparagraph (A)(i) shall be the 3-
consecutive-month period beginning with October
2008.''.
(b) Scope of Application.--The adjustments in the FMAP for a State
under this section shall apply for purposes of title XIX of the Social
Security Act and shall not apply with respect to--
(1) disproportionate share hospital payments described in
section 1923 of such Act (42 U.S.C. 1396r-4);
(2) payments under title IV of such Act (42 U.S.C. 601 et
seq.) (except that the increases under paragraphs (1) and (2)
of subsection (a) shall apply to payments under part E of title
IV of such Act (42 U.S.C. 670 et seq.) and, for purposes of the
application of this section to the District of Columbia,
payments under such part shall be deemed to be made on the
basis of the FMAP applied with respect to such District for
purposes of title XIX and as increased under subsection
(a)(2));
(3) any payments under title XXI of such Act (42 U.S.C.
1397aa et seq.);
(4) any payments under title XIX of such Act that are based
on the enhanced FMAP described in section 2105(b) of such Act
(42 U.S.C. 1397ee(b)); or
(5) any payments under title XIX of such Act that are
attributable to expenditures for medical assistance provided to
individuals made eligible under a State plan under title XIX of
the Social Security Act (including under any waiver under such
title or under section 1115 of such Act (42 U.S.C. 1315))
because of income standards (expressed as a percentage of the
poverty line) for eligibility for medical assistance that are
higher than the income standards (as so expressed) for such
eligibility as in effect on July 1, 2008, (including as such
standards were proposed to be in effect under a State law
enacted but not effective as of such date or a State plan
amendment or waiver request under title XIX of such Act that
was pending approval on such date).
(c) State Ineligibility; Limitation; Special Rules.--
(1) Maintenance of eligibility requirements.--
(A) In general.--Subject to subparagraph (B) and
(C), a State is not eligible for an increase in its
FMAP under subsection (a) if eligibility standards,
methodologies, or procedures under its State plan under
title XIX of the Social Security Act (including any
waiver under such title or under section 1115 of such
Act (42 U.S.C. 1315)) are more restrictive than the
eligibility standards, methodologies, or procedures,
respectively, under such plan (or waiver) as in effect
on July 1, 2008.
(B) State reinstatement of eligibility permitted.--
Subject to subparagraph (C), a State that has
restricted eligibility standards, methodologies, or
procedures under its State plan under title XIX of the
Social Security Act (including any waiver under such
title or under section 1115 of such Act (42 U.S.C.
1315)) after July 1, 2008, is no longer ineligible
under subparagraph (A) beginning with the first
calendar quarter in which the State has reinstated
eligibility standards, methodologies, or procedures
that are no more restrictive than the eligibility
standards, methodologies, or procedures, respectively,
under such plan (or waiver) as in effect on July 1,
2008.
(C) Special rules.--A State shall not be ineligible
under subparagraph (A)--
(i) for the fiscal quarters before October
1, 2011, on the basis of a restriction that was
applied after July 1, 2008, and before the date
of the enactment of this Act, if the State
prior to October 1, 2011, has reinstated
eligibility standards, methodologies, or
procedures that are no more restrictive than
the eligibility standards, methodologies, or
procedures, respectively, under such plan (or
waiver) as in effect on July 1, 2008; or
(ii) on the basis of a restriction that was
directed to be made under State law as in
effect on July 1, 2008, and would have been in
effect as of such date, but for a delay in the
effective date of a waiver under section 1115
of such Act with respect to such restriction.
(2) Compliance with prompt pay requirements.--
(A) Application to practitioners.--
(i) In general.--Subject to the succeeding
provisions of this subparagraph, no State shall
be eligible for an increased FMAP rate as
provided under this section for any claim
received by a State from a practitioner subject
to the terms of section 1902(a)(37)(A) of the
Social Security Act (42 U.S.C. 1396a(a)(37)(A))
for such days during any period in which that
State has failed to pay claims in accordance
with such section as applied under title XIX of
such Act.
(ii) Reporting requirement.--Each State
shall report to the Secretary, on a quarterly
basis, its compliance with the requirements of
clause (i) as such requirements pertain to
claims made for covered services during each
month of the preceding quarter.
(iii) Waiver authority.--The Secretary may
waive the application of clause (i) to a State,
or the reporting requirement imposed under
clause (ii), during any period in which there
are exigent circumstances, including natural
disasters, that prevent the timely processing
of claims or the submission of such a report.
(iv) Application to claims.--Clauses (i)
and (ii) shall only apply to claims made for
covered services after the date of enactment of
this Act.
(B) Application to nursing facilities and
hospitals.--The provisions of subparagraph (A) shall
apply with respect to a nursing facility or hospital,
insofar as it is paid under title XIX of the Social
Security Act on the basis of submission of claims, in
the same or similar manner (but within the same
timeframe) as such provisions apply to practitioners
described in such subparagraph.
(3) State's application toward rainy day fund.--A State is
not eligible for an increase in its FMAP under paragraphs (2)
or (3) of subsection (a) if any amounts attributable (directly
or indirectly) to such increase are deposited or credited into
any reserve or rainy day fund of the State.
(4) No waiver authority.--Except as provided in paragraph
(2)(A)(iii), the Secretary may not waive the application of
this subsection or subsection (d) under section 1115 of the
Social Security Act or otherwise.
(5) Limitation of fmap to 100 percent.--In no case shall an
increase in FMAP under this section result in an FMAP that
exceeds 100 percent.
(d) Requirements.--
(1) State reports.--Each State that is paid additional
Federal funds as a result of this section shall, not later than
September 30, 2014, submit a report to the Secretary, in such
form and such manner as the Secretary shall determine,
regarding how the additional Federal funds were expended.
(2) Additional requirement for certain states.--In the case
of a State that requires political subdivisions within the
State to contribute toward the non-Federal share of
expenditures under the State Medicaid plan required under
section 1902(a)(2) of the Social Security Act (42 U.S.C.
1396a(a)(2)), the State is not eligible for an increase in its
FMAP under paragraphs (2) or (3) of subsection (a) if it
requires that such political subdivisions pay for quarters
during the ARRA transitional assistance period a greater
percentage of the non-Federal share of such expenditures, or a
greater percentage of the non-Federal share of payments under
section 1923, than the respective percentage that would have
been required by the State under such plan on September 30,
2008, prior to application of this section.
(e) Definitions.--In this Act, except as otherwise provided:
(1) ARRA.--The term ``ARRA'' means the American Recovery
and Reinvestment Act of 2009 (Public Law 111-5; 123 Stat. 140).
(2) FMAP.--The term ``FMAP''' means the Federal medical
assistance percentage, as defined in section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)), as determined without
regard to this section except as otherwise specified.
(3) Poverty line.--The term ``poverty line'' has the
meaning given such term in section 673(2) of the Community
Services Block Grant Act (42 U.S.C. 9902(2)), including any
revision required by such section.
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(5) State.--The term ``State'' has the meaning given such
term in section 1101(a)(1) of the Social Security Act (42
U.S.C. 1301(a)(1)) for purposes of title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(f) Sunset.--This section shall not apply to items and services
furnished after the end of the ARRA transitional assistance period.
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