[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1354 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 1354
To amend titles XVIII and XIX of the Social Security Act to make
improvements to the treatment of the United States territories under
the Medicare and Medicaid programs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 25, 2019
Ms. Plaskett (for herself, Miss Gonzalez-Colon of Puerto Rico, Mrs.
Radewagen, Mr. San Nicolas, Mr. Serrano, and Ms. Velazquez) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to make
improvements to the treatment of the United States territories under
the Medicare and Medicaid programs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Territories Health
Equity Act of 2019''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICAID
Sec. 101. Elimination of general Medicaid funding limitations (``cap'')
for territories.
Sec. 102. Elimination of specific Federal medical assistance percentage
(FMAP) limitation for territories.
Sec. 103. Application of Medicaid waiver authority to all of the
territories.
Sec. 104. Permitting Medicaid DSH allotments for territories.
TITLE II--MEDICARE
Subtitle A--Part A
Sec. 201. Calculation of Medicare DSH payments for IPPS hospitals in
Puerto Rico.
Sec. 202. Rebasing target amount for hospitals in territories.
Sec. 203. Medicare DSH target adjustment for hospitals in territories.
Subtitle B--Part B
Sec. 211. Application of part B deemed enrollment process to residents
of Puerto Rico; special enrollment period
and limit on late enrollment penalties.
Subtitle C--Medicare Advantage (Part C)
Sec. 221. Adjustment in benchmark for low-base payment counties in
Puerto Rico.
Subtitle D--Part D
Sec. 231. Improved use of allocated prescription drug funds by
territories.
Sec. 232. Report on treatment of territories under Medicare part D.
TITLE III--MISCELLANEOUS
Sec. 301. Modified treatment of territories with respect to application
of ACA annual health insurance provider
fees.
Sec. 302. Medicaid and CHIP territory transparency and information.
Sec. 303. Report on exclusion of territories from Exchanges.
Sec. 304. Access to coverage for individuals in certain areas without
any available Exchange plans.
Sec. 305. Extension of family-to-family health information centers
program to territories.
TITLE I--MEDICAID
SEC. 101. ELIMINATION OF GENERAL MEDICAID FUNDING LIMITATIONS (``CAP'')
FOR TERRITORIES.
(a) In General.--Section 1108 of the Social Security Act (42 U.S.C.
1308) is amended--
(1) in subsection (f), in the matter preceding paragraph
(1), by striking ``subsection (g)'' and inserting ``subsections
(g) and (h)'';
(2) in subsection (g)(2), in the matter preceding
subparagraph (A), by inserting ``subsection (h)'' after
``subject to''; and
(3) by adding at the end the following new subsection:
``(h) Sunset of Medicaid Funding Limitations for Puerto Rico, the
Virgin Islands, Guam, the Northern Mariana Islands, and American
Samoa.--Subsections (f) and (g) shall not apply to Puerto Rico, the
Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa
beginning with fiscal year 2020.''.
(b) Conforming Amendments.--
(1) Section 1902(j) of the Social Security Act (42 U.S.C.
1396a(j)) is amended by striking ``, the limitation in section
1108(f),''.
(2) Section 1903(u) of the Social Security Act (42 U.S.C.
1396b(u)) is amended by striking paragraph (4).
(c) Effective Date.--The amendments made by this section shall
apply beginning with fiscal year 2020.
SEC. 102. ELIMINATION OF SPECIFIC FEDERAL MEDICAL ASSISTANCE PERCENTAGE
(FMAP) LIMITATION FOR TERRITORIES.
Section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is
amended, in clause (2), by inserting ``for fiscal years before fiscal
year 2020'' after ``American Samoa''.
SEC. 103. APPLICATION OF MEDICAID WAIVER AUTHORITY TO ALL OF THE
TERRITORIES.
(a) In General.--Section 1902(j) of the Social Security Act (42
U.S.C. 1396a(j)) is amended--
(1) by striking ``American Samoa and the Northern Mariana
Islands'' and inserting ``Puerto Rico, the Virgin Islands,
Guam, the Northern Mariana Islands, and American Samoa'';
(2) by striking ``American Samoa or the Northern Mariana
Islands'' and inserting ``Puerto Rico, the Virgin Islands,
Guam, the Northern Mariana Islands, or American Samoa'';
(3) by inserting ``(1)'' before ``Notwithstanding'';
(4) by inserting ``except as otherwise provided in this
subsection,'' after ``Notwithstanding any other requirement of
this title''; and
(5) by adding at the end the following:
``(2) The Secretary may not waive under this subsection the
requirement of subsection (a)(10)(A)(i)(IX) (relating to coverage of
adults formerly under foster care) with respect to any territory.''.
(b) Effective Date.--The amendments made by this section shall
apply beginning October 1, 2019.
SEC. 104. PERMITTING MEDICAID DSH ALLOTMENTS FOR TERRITORIES.
Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f))
is amended--
(1) in paragraph (6), by adding at the end the following
new subparagraph:
``(C) Territories.--
``(i) Fiscal year 2020.--For fiscal year
2020, the DSH allotment for Puerto Rico, the
Virgin Islands, Guam, the Northern Mariana
Islands, and American Samoa shall bear the same
ratio to $300,000,000 as the ratio of the
number of individuals who are low-income or
uninsured and residing in such respective
territory (as estimated from time to time by
the Secretary) bears to the sums of the number
of such individuals residing in all of the
territories.
``(ii) Subsequent fiscal year.--For each
subsequent fiscal year, the DSH allotment for
each such territory is subject to an increase
in accordance with paragraph (3).''; and
(2) in paragraph (9), by inserting before the period at the
end the following: ``, and includes, beginning with fiscal year
2020, Puerto Rico, the Virgin Islands, Guam, the Northern
Mariana Islands, and American Samoa''.
TITLE II--MEDICARE
Subtitle A--Part A
SEC. 201. CALCULATION OF MEDICARE DSH PAYMENTS FOR IPPS HOSPITALS IN
PUERTO RICO.
Section 1886(d)(9)(D)(iii) of the Social Security Act (42 U.S.C.
1395ww(d)(9)(D)(iii)) is amended to read as follows:
``(iii) Subparagraph (F) (relating to disproportionate
share payments), including application of subsection (r),
except that for this purpose--
``(I) the sum described in clause (ii) of this
subparagraph shall be substituted for the sum referred
to in paragraph (5)(F)(ii)(I); and
``(II) for discharges occurring on or after October
1, 2019, subclause (I) of paragraph (5)(F)(vi) shall be
applied by substituting for the numerator described in
such subclause the number of subsection (d) Puerto Rico
hospital's patient days for the cost reporting period
involved which were made up of patients who (for such
days) were entitled to benefits under part A of this
title and were--
``(aa) entitled to supplementary security
income benefits (excluding any State
supplementation) under title XVI of this Act;
``(bb) eligible for medical assistance
under a State plan under title XIX; or
``(cc) receiving aid or assistance under
any plan of the State approved under title I,
X, XIV, or XVI.''.
SEC. 202. REBASING TARGET AMOUNT FOR HOSPITALS IN TERRITORIES.
Section 1886(b)(3) of the Social Security Act (42 U.S.C.
1395ww(b)(3)) is amended by adding at the end the following new
subparagraph:
``(M)(i) For each cost reporting period beginning
on or after October 1, 2019, in the case of a hospital
located in a territory of the United States, there
shall be substituted for the target amount otherwise
determined under subparagraph (A) the rebased target
amount (as defined in clause (ii)), if such
substitution results in an amount of payment under this
section to the hospital for such period that is greater
than the amount of payment that would be made under
this section to the hospital for such period if this
subparagraph were not to apply.
``(ii) For purposes of this subparagraph, the term
`rebased target amount' has the meaning given the term
`target amount' in subparagraph (A), except that--
``(I) there shall be substituted for the
preceding 12-month cost reporting period the
12-month cost reporting period beginning during
fiscal year 2015 (or, at the option of the
hospital, beginning during fiscal year 2017);
``(II) any reference in subparagraph (A)(i)
to the `first such cost reporting period' is
deemed a reference to the first cost reporting
period following the 12-month cost reporting
period beginning during fiscal year 2015 (or,
at the option of the hospital, beginning during
fiscal year 2017); and
``(III) the applicable percentage increase
shall only be applied under subparagraph
(B)(ii) for cost reporting periods beginning on
or after October 1, 2019.
``(iii) Nothing in this subparagraph shall affect
any pending request by a hospital for a new target
amount for any cost reporting period beginning during a
fiscal year before fiscal year 2020.''.
SEC. 203. MEDICARE DSH TARGET ADJUSTMENT FOR HOSPITALS IN TERRITORIES.
Section 1886(b)(3) of the Social Security Act (42 U.S.C.
1395ww(b)(3)), as amended by section 202, is further amended by adding
at the end the following new subparagraph:
``(N)(i) For each cost reporting period beginning
on or after October 1, 2019, in the case of a hospital
that is located in a territory of the United States
other than Puerto Rico and that would be a subsection
(d) hospital if it were located in one of the 50
States, the target amount shall be increased by--
``(I) in the case that such hospital has a
disproportionate patient percentage of not less
than 15 percent and not greater than 40
percent, 10 percent; and
``(II) in the case that such hospital has a
disproportionate patient percentage of greater
than 40 percent, 10 percent plus 60 percent of
the number of percentage points by which such
hospital's disproportionate patient percentage
exceeds 40 percent.
``(ii) For purposes of this subparagraph, the term
`disproportionate patient percentage' has the meaning
given such term in subsection (d)(5)(F)(vi), except
that in applying such meaning any reference under such
subsection to individuals entitled to supplementary
security income under title XVI shall be deemed for
purposes of this subparagraph to include individuals--
``(I) eligible for medical assistance under
a State plan under title XIX; or
``(II) receiving aid or assistance under
any plan of the territory approved under title
I, X, XIV, or XVI.''.
Subtitle B--Part B
SEC. 211. APPLICATION OF PART B DEEMED ENROLLMENT PROCESS TO RESIDENTS
OF PUERTO RICO; SPECIAL ENROLLMENT PERIOD AND LIMIT ON
LATE ENROLLMENT PENALTIES.
(a) Application of Part B Deemed Enrollment Process to Residents of
Puerto Rico.--Section 1837(f)(3) of the Social Security Act (42 U.S.C.
1395p(f)(3)) is amended by striking ``, exclusive of Puerto Rico''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to individuals whose initial enrollment period under section
1837(d) of the Social Security Act begins on or after the first day of
the effective month, specified by the Secretary of Health and Human
Services under section 1839(j)(1)(C) of such Act, as added by
subsection (c)(2).
(c) Transition Providing Special Enrollment Period and Limit on
Late Enrollment Penalties for Certain Medicare Beneficiaries.--Section
1839 of the Social Security Act (42 U.S.C. 1395r) is amended--
(1) in the first sentence of subsection (b), by inserting
``subject to section 1839(j)(2),'' after ``subsection (i)(4) or
(l) of section 1837,''; and
(2) by adding at the end the following new subsection:
``(j) Special Rules for Certain Residents of Puerto Rico.--
``(1) Special enrollment period, coverage period for
residents who are eligible but not enrolled.--
``(A) In general.--In the case of a transition
individual (as defined in paragraph (3)) who is not
enrolled under this part as of the day before the first
day of the effective month (as defined in subparagraph
(C)), the Secretary shall provide for a special
enrollment period under section 1837 of 7 months
beginning with such effective month during which the
individual may be enrolled under this part.
``(B) Coverage period.--In the case of such an
individual who enrolls during such special enrollment
period, the coverage period under section 1838 shall
begin on the first day of the second month after the
month in which the individual enrolls.
``(C) Effective month defined.--In this section,
the term `effective month' means a month, not earlier
than October 2020 and not later than January 2021,
specified by the Secretary.
``(2) Reduction in late enrollment penalties for current
enrollees and individuals enrolling during transition.--
``(A) In general.--In the case of a transition
individual who is enrolled under this part as of the
day before the first day of the effective month or who
enrolls under this part on or after the date of the
enactment of this subsection but before the end of the
special enrollment period under paragraph (1)(A), the
amount of the late enrollment penalty imposed under
section 1839(b) shall be recalculated by reducing the
penalty to 15 percent of the penalty otherwise
established.
``(B) Application.--Subparagraph (A) shall be
applied in the case of a transition individual who--
``(i) is enrolled under this part as of the
month before the effective month, for premiums
for months beginning with such effective month;
or
``(ii) enrolls under this part on or after
the date of the enactment of this Act and
before the end of the special enrollment period
under paragraph (1)(A), for premiums for months
during the coverage period under this part
which occur during or after the effective
month.
``(C) Loss of reduction if individual terminates
enrollment.--Subparagraph (A) shall not apply to a
transition individual if the individual terminates
enrollment under this part after the end of the special
enrollment period under paragraph (1).
``(3) Transition individual defined.--In this section, the
term `transition individual' means an individual who resides in
Puerto Rico and who would have been deemed enrolled under this
part pursuant to section 1837(f) before the first day of the
effective month but for the fact that the individual was a
resident of Puerto Rico, regardless of whether the individual
is enrolled under this part as of such first day.''.
Subtitle C--Medicare Advantage (Part C)
SEC. 221. ADJUSTMENT IN BENCHMARK FOR LOW-BASE PAYMENT COUNTIES IN
PUERTO RICO.
Section 1853(n) of the Social Security Act (42 U.S.C. 1395w-23(n))
is amended--
(1) in paragraph (1), by striking ``and (5)'' and inserting
``(5), and (6)'';
(2) in paragraph (4), by striking ``In no case'' and
inserting ``Subject to paragraph (6), in no case''; and
(3) by adding at the end the following new paragraph:
``(6) Special rules for blended benchmark amount for
territories.--
``(A) In general.--Subject to paragraph (2), the
blended benchmark amount for an area in a territory for
a year (beginning with 2020) shall not be less than 80
percent of the national average of the base payment
amounts specified in subparagraph (2)(E) for such year
for areas within the 50 States and the District of
Columbia.
``(B) Limitation.--In no case shall the blended
benchmark amount for an area in a territory for a year
under subparagraph (A) exceed the lowest blended
benchmark amount for any area within the 50 States and
the District of Columbia for such year.''.
Subtitle D--Part D
SEC. 231. IMPROVED USE OF ALLOCATED PRESCRIPTION DRUG FUNDS BY
TERRITORIES.
Section 1935(e) of the Social Security Act (42 U.S.C. 1396u-5(e))
is amended by adding at the end the following new paragraph:
``(5) Improved use of funds for low-income part d eligible
individuals.--This subsection shall be applied beginning with
fiscal year 2020 as follows, notwithstanding any other
provision of this title:
``(A) Clarifying state flexibility to cover non-
dual-eligible individuals.--In this title, the term
`medical assistance' includes financial assistance
furnished by a State under this subsection to part D
eligible individuals who, if they were residing in one
of the 50 States or the District of Columbia, would
qualify as subsidy eligible individuals under section
1860D-14(a)(3), and without regard to whether such
individuals otherwise qualify for medical assistance
under this title.
``(B) 100 percent fmap to reflect no state matching
required for part d low income subsidies.--The Federal
medical assistance percentage applicable to the
assistance furnished under this subsection is 100
percent.
``(C) Limited funding for special rules.--
Subparagraphs (A) and (B), and the provision of medical
assistance for covered part D drugs to low-income part
D eligible individuals for a State and period under
this subsection, is limited to the amount specified in
paragraph (3) for such State and period.''.
SEC. 232. REPORT ON TREATMENT OF TERRITORIES UNDER MEDICARE PART D.
Paragraph (4) of section 1935(e) of the Social Security Act (42
U.S.C. 1396u-5(e)) is amended to read as follows:
``(4) Report on application of subsection.--
``(A) In general.--Not later than February 1, 2020,
the Secretary shall submit to Congress a report on the
application of this subsection during the period
beginning fiscal year 2006 and ending fiscal year 2019.
``(B) Information to be included in report.--Such
report shall include--
``(i) program guidance issued by the
Secretary to implement this subsection;
``(ii) for each territory, information on
the increased amount under paragraph (3) and
how the territory has applied such amount,
including the territory's program design,
expenditures, and number of individuals (and
dual-eligible individuals) assisted; and
``(iii) differences between how such
territories are treated under part D of title
XVIII and under this title compared with the
treatment of the 50 States and the District of
Columbia under such part and this title for
different fiscal years within the period
covered under the report.
``(C) Recommendations.--Such report shall include
recommendations for improving prescription drug
coverage for low-income individuals in each territory,
including recommendations regarding each of the
following alternative approaches:
``(i) Adjusting the aggregate amount
specified in paragraph (3)(B).
``(ii) Allowing residents of the
territories to be subsidy eligible individuals
under section 1860D-14, notwithstanding
subsection (a)(3)(F) of such section, or
providing substantially equivalent low-income
prescription drug subsidies to such
residents.''.
TITLE III--MISCELLANEOUS
SEC. 301. MODIFIED TREATMENT OF TERRITORIES WITH RESPECT TO APPLICATION
OF ACA ANNUAL HEALTH INSURANCE PROVIDER FEES.
Section 9010 of the Patient Protection and Affordable Care Act (26
U.S.C. 4001 note prec.) is amended--
(1) in subsection (b)(1), by inserting ``subject to
subsection (k)(1),'' after ``With respect to each covered
entity,''; and
(2) by adding at the end the following:
``(k) Special Rules for Treatment of Territories.--
``(1) In general.--In applying this section with respect to
United States health risks located outside of the 50 States or
the District of Columbia for years beginning with 2020--
``(A) the amount of the fee under subsection (b)
shall be 50 percent of the amount of the fee otherwise
determined;
``(B) the Secretary shall deposit the amount of
such fees collected for each territory into a separate
account; and
``(C) amounts in such an account for a territory
for a year are appropriated and shall be available to
the territory in accordance with paragraph (2).
``(2) Availability of funds.--Amounts made available to a
territory under paragraph (1)(C) with respect to a territory
for a year shall be made available to the territory, upon
application of the territory to the Secretary of Health and
Human Services, only for the following purposes, as elected by
the territory in such application:
``(A) Increased prescription drug assistance for
low-income part d eligible individuals.--For increasing
the amount of funds made available to the territory
under section 1935(e)(3) of the Social Security Act (42
U.S.C. 1396u-5(e)(3)) for assistance for low-income
part D eligible individuals in obtaining part D covered
drugs.
``(B) Satisfying state medicaid matching
requirement.--For the territory to meet non-Federal
matching requirements imposed with respect to obtaining
Federal financial participation under title XIX of the
Social Security Act.''.
SEC. 302. MEDICAID AND CHIP TERRITORY TRANSPARENCY AND INFORMATION.
(a) Publication of Information on Federal Expenditures Under
Medicaid and CHIP in the Territories.--Not later than 180 days after
the date of the enactment of this Act, the Secretary of Health and
Human Services shall publish, and periodically update, on the Internet
site of the Centers for Medicare & Medicaid Services information on
Medicaid and CHIP carried out in the territories of the United States.
Such information shall include, with respect to each such territory--
(1) the income levels established by the territory for
purposes of eligibility of an individual to receive medical
assistance under Medicaid or child health assistance under
CHIP;
(2) the number of individuals enrolled in Medicaid and CHIP
in such territory;
(3) any State plan amendments in effect to carry out
Medicaid or CHIP in such territory;
(4) any waiver of the requirements of title XIX or title
XXI issued by the Secretary to carry out Medicaid or CHIP in
the territory, including a waiver under section 1115 of the
Social Security Act (42 U.S.C. 1315), any application for such
a waiver, and any documentation related to such application
(including correspondence);
(5) the amount of the Federal and non-Federal share of
expenditures under Medicaid and CHIP in such territory;
(6) the systems in place for the furnishing of health care
items and services under Medicaid and CHIP in such territory;
(7) the design of CHIP in such territory; and
(8) other information regarding the carrying out of
Medicaid and CHIP in the territory that is published on such
Internet site with respect to carrying out Medicaid and CHIP in
each State and the District of Columbia.
(b) Definitions.--In this section:
(1) CHIP.--The term ``CHIP'' means the State Children's
Health Insurance Program under title XXI of the Social Security
Act.
(2) Medicaid.--The term ``Medicaid'' means the Medicaid
program under title XIX of the Social Security Act.
(3) Territory.--The term ``territory of the United States''
includes Puerto Rico, the Virgin Islands of the United States,
Guam, the Northern Mariana Islands, and American Samoa.
SEC. 303. REPORT ON EXCLUSION OF TERRITORIES FROM EXCHANGES.
(a) In General.--Not later than February 1, 2020, the Secretary of
Health and Human Services shall submit to Congress a report that
details the adverse impacts in each territory from the practical
exclusion of the territories from the provisions of part II of subtitle
D of title I of the Patient Protection and Affordable Care Act insofar
as such provisions provide for the establishment of an American Health
Benefit Exchange or the administration of a federally facilitated
Exchange in each State and in the District of Columbia for the purpose
of making health insurance more affordable and accessible for
individuals and small businesses.
(b) Information in Report.--The report shall include information on
the following:
(1) An estimate of the total number of uninsured and
underinsured individuals residing in each territory with
respect to health insurance coverage.
(2) A description of the number of health insurance issuers
in each territory and the health insurance plans these issuers
offer.
(3) An estimate of the number of individuals residing in
each territory who are denied premium and cost-sharing
assistance that would otherwise be available to them for
obtaining health insurance coverage through an Exchange if they
resided in one of the 50 States or in the District of Columbia.
(4) An estimate of the amount of Federal assistance
described in paragraph (3) that is not being made available to
residents of each territory.
(5) An estimate of the number of small employers in each
territory that would be eligible to purchase health insurance
coverage through a Small Business Health Options Program (SHOP)
Marketplace that would operate as part of an Exchange if the
employers were in one of the 50 States or in the District of
Columbia.
SEC. 304. ACCESS TO COVERAGE FOR INDIVIDUALS IN CERTAIN AREAS WITHOUT
ANY AVAILABLE EXCHANGE PLANS.
Part 2 of subtitle D of title I of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031 et seq.) is amended by adding at
the end the following:
``SEC. 1314. ACCESS TO COVERAGE FOR INDIVIDUALS IN CERTAIN AREAS
WITHOUT ANY AVAILABLE EXCHANGE PLANS.
``(a) In General.--
``(1) Coverage through dc shop exchange.--Not later than 3
months after the date of enactment of this section, the
Secretary, in consultation with the Secretary of the Treasury
and the Director of the Office of Personnel Management, shall
establish a mechanism to ensure that, for any plan year
beginning on or after the date described in subsection (d), any
individual described in paragraph (2) may enroll in health
insurance coverage in the small group market through the
Exchange operating in the District of Columbia, including the
health insurance coverage that is available to Members of
Congress and congressional staff (as defined in section
1312(d)(3)(D)).
``(2) Individual described.--An individual described in
this paragraph is any individual who--
``(A) is not eligible to enroll in an employer-
sponsored health plan (excluding such a plan that would
not be considered minimum essential coverage due to the
application of subparagraph (C) of section 36B(c)(2) of
the Internal Revenue Code of 1986 if such subparagraph
applied to such plan); and
``(B) is a bona fide resident of any possession of
the United States (as determined under section 937(a)
of such Code) in which the Secretary certifies that no
qualified health plan is offered through an Exchange
established under this title.
``(3) Possession of the united states.--For purposes of
this section, the term `possession of the United States' shall
include such possessions as are specified in section 937(a)(1)
of the Internal Revenue Code of 1986.
``(b) Premium Assistance Tax Credits and Cost-Sharing.--Any
individual described in subsection (a)(2) who enrolls in health
insurance coverage through the Exchange operating in the District of
Columbia pursuant to subsection (a)(1) shall be eligible for any
premium tax credit under section 36B of the Internal Revenue Code of
1986, reduced cost-sharing under section 1402, and advance
determination and payment of such credits or such reductions under
section 1412, that the individual would otherwise be eligible for if
enrolling as a resident of the District of Columbia in health insurance
coverage in the individual market through the Exchange operating in the
District of Columbia.
``(c) Treatment of Possessions.--
``(1) Payments to possessions.--
``(A) Mirror code possession.--The Secretary of the
Treasury shall periodically (but not less frequently
than annually) pay to each possession of the United
States with a mirror code tax system amounts equal to
the loss to that possession by reason of the
application of this section (determined without regard
to paragraph (2)) with respect to taxable years
beginning after the date described in subsection (d).
Such amounts shall be determined by the Secretary of
the Treasury based on information provided by the
government of the respective possession.
``(B) Other possessions.--The Secretary of the
Treasury shall periodically (but not less frequently
than annually) pay to each possession of the United
States which does not have a mirror code tax system
amounts estimated by the Secretary of the Treasury as
being equal to the aggregate benefits that would have
been provided to residents of such possession by reason
of the application of this section for any taxable
years beginning after the date described in subsection
(d) if a mirror code tax system had been in effect in
such possession. The preceding sentence shall not apply
with respect to any possession of the United States
unless such possession has a plan, which has been
approved by the Secretary of the Treasury, under which
such possession will promptly distribute such payments
to the residents of such possession.
``(2) Coordination with credit allowed against united
states income taxes.--No credit shall be allowed against United
States income taxes for any taxable year under section 36B of
the Internal Revenue Code of 1986 to any person--
``(A) to whom a credit is allowed against taxes
imposed by the possession by reason of this section
(determined without regard to this paragraph) for such
taxable year, or
``(B) who is eligible for a payment under a plan
described in paragraph (1)(B) with respect to such
taxable year.
``(3) Mirror code tax system.--For purposes of this
subsection, the term `mirror code tax system' means, with
respect to any possession of the United States, the income tax
system of such possession if the income tax liability of the
residents of such possession under such system is determined by
reference to the income tax laws of the United States as if
such possession were the United States.
``(4) Treatment of payments.--For purposes of section
1324(b)(2) of title 31, United States Code, or any similar rule
of law, the payments under this subsection shall be treated in
the same manner as a refund due from the credit allowed under
section 36B of the Internal Revenue Code of 1986.
``(d) Date Described.--The date described in this subsection is the
date on which the Secretary establishes the mechanism described in
subsection (a)(1).''.
SEC. 305. EXTENSION OF FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS
PROGRAM TO TERRITORIES.
Section 501(c)(3)(C) of the Social Security Act (42 U.S.C. 701(c))
is amended by striking ``years 2018 and 2019'' and inserting ``year
2018 and each fiscal year thereafter''.
<all>