[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3253 Received in Senate (RDS)]
<DOC>
116th CONGRESS
1st Session
H. R. 3253
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 19, 2019
Received
_______________________________________________________________________
AN ACT
To provide for certain extensions with respect to the Medicaid program
under title XIX of the Social Security Act, 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 ``Empowering
Beneficiaries, Ensuring Access, and Strengthening Accountability Act of
2019''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; Table of contents.
Sec. 2. Extension of Money Follows the Person Rebalancing
Demonstration.
Sec. 3. Clarifying authority of State Medicaid fraud and abuse control
units to investigate and prosecute cases of
Medicaid patient abuse and neglect in any
setting.
Sec. 4. Extension of protection for Medicaid recipients of home and
community-based services against spousal
impoverishment.
Sec. 5. Extension of the Community Mental Health Services Demonstration
Program.
Sec. 6. Preventing inappropriately low rebates under Medicaid drug
rebate program.
Sec. 7. Medicaid Improvement Fund.
Sec. 8. Determination of budgetary effects.
SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING
DEMONSTRATION.
(a) In General.--
(1) Funding.--Section 6071(h) of the Deficit Reduction Act
of 2005 (42 U.S.C. 1396a note) is amended--
(A) in paragraph (1)--
(i) in subparagraph (E), by striking
``and'' at the end;
(ii) in subparagraph (F)--
(I) by striking ``subject to
paragraph (3), 132,000,000'' and
inserting ``$132,000,000''; and
(II) by striking the period at the
end and inserting a semicolon; and
(iii) by adding at the end the following
new subparagraphs:
``(G) $417,000,000 for fiscal year 2020;
``(H) $450,000,000 for each of fiscal years 2021
through 2023; and
``(I) $225,000,000 for fiscal year 2024.'';
(B) in paragraph (2)--
(i) by striking ``Subject to paragraph (3),
amounts'' and inserting ``Amounts''; and
(ii) by striking ``2021'' and inserting
``2024''; and
(C) by striking paragraph (3).
(2) Research and evaluation.--Section 6071(g) of the
Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is
amended--
(A) in paragraph (2), by striking ``2016'' and
inserting ``2024''; and
(B) in paragraph (3), by inserting ``and for each
of fiscal years 2019 through 2024,'' after ``2016,''.
(b) Changes to Institutional Residency Period Requirement.--
(1) In general.--Section 6071(b)(2) of the Deficit
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
(A) in subparagraph (A)(i), by striking ``90'' and
inserting ``60''; and
(B) by striking the flush sentence after
subparagraph (B).
(2) Effective date.--The amendments made by paragraph (1)
shall take effect on the date that is 30 days after the date of
the enactment of this Act.
(c) Updates to State Application Requirements.--Section 6071(c) of
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
(1) in paragraph (3), by striking ``, which shall include''
and all that follows through ``2007'';
(2) in paragraph (7)--
(A) in the paragraph heading, by striking
``Rebalancing'' and inserting ``Expenditures'';
(B) in subparagraph (A), by adding ``and'' at the
end; and
(C) in subparagraph (B)--
(i) in clause (i), by striking ``and'' at
the end;
(ii) in clause (ii), by striking the period
at the end and inserting a semicolon; and
(iii) by adding at the end the following:
``(iii) include a work plan that describes for each
Federal fiscal year that occurs during the proposed MFP
demonstration project--
``(I) the use of grant funds for each
proposed initiative that is designed to
accomplish the objective described in
subsection (a)(1), including a funding source
for each activity that is part of each such
proposed initiative;
``(II) an evaluation plan that identifies
expected results for each such proposed
initiative; and
``(III) a sustainability plan for
components of such proposed initiatives that
are intended to improve transitions, which
shall be updated with actual expenditure
information for each Federal fiscal year that
occurs during the MFP demonstration project;
and
``(iv) contain assurances that grant funds used to
accomplish the objective described in subsection (a)(1)
shall be obligated not later than 24 months after the
date on which the funds are awarded and shall be
expended not later than 60 months after the date on
which the funds are awarded (unless the Secretary
approves a waiver of either such requirement).''; and
(3) in paragraph (13)--
(A) in subparagraph (A), by striking ``; and'' and
inserting ``, and in such manner as will meet the
reporting requirements set forth for the Transformed
Medicaid Statistical Management Information System (T-
MSIS);'';
(B) by redesignating subparagraph (B) as
subparagraph (D); and
(C) by inserting after subparagraph (A) the
following:
``(B) the State shall report on a quarterly basis
on the use of grant funds by distinct activity, as
described in the approved work plan, and by specific
population as targeted by the State;
``(C) if the State fails to report the information
required under subparagraph (B), fails to report such
information on a quarterly basis, or fails to make
progress under the approved work plan, the State shall
implement a corrective action plan and any lack of
progress under the approved work plan may result in
withholding of grant funds made available to the State;
and''.
(d) Funding for Quality Assurance and Improvement; Technical
Assistance; Oversight.--Section 6071(f) of the Deficit Reduction Act of
2005 (42 U.S.C. 1396a note) is amended by striking paragraph (2) and
inserting the following:
``(2) Funding.--From the amounts appropriated under
subsection (h)(1) for each of fiscal years 2019 through 2024,
$1,000,000 shall be available to the Secretary for each such
fiscal year to carry out this subsection.''.
(e) Best Practices Evaluation.--Section 6071 of the Deficit
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by adding at
the end the following:
``(i) Best Practices.--
``(1) Report.--The Secretary, directly or through grant or
contract, shall submit a report to the President and Congress
not later than September 30, 2020, that contains findings and
conclusions on best practices from the State MFP demonstration
projects carried out with grants made under this section. The
report shall include information and analyses with respect to
the following:
``(A) The most effective State strategies for
transitioning beneficiaries from institutional to
qualified community settings carried out under the
State MFP demonstration projects and how such
strategies may vary for different types of
beneficiaries, such as beneficiaries who are aged,
physically disabled, intellectually or developmentally
disabled, or individuals with serious mental illnesses,
and other targeted waiver beneficiary populations.
``(B) The most common and the most effective State
uses of grant funds carried out under the State MFP
demonstration projects for transitioning beneficiaries
from institutional to qualified community settings and
improving health outcomes, including differentiating
funding for current initiatives that are designed for
such purpose and funding for proposed initiatives that
are designed for such purpose.
``(C) The most effective State approaches carried
out under State MFP demonstration projects for
improving person-centered care and planning.
``(D) Identification of program, financing, and
other flexibilities available under the State MFP
demonstration projects, that are not available under
the traditional Medicaid program, and which directly
contributed to successful transitions and improved
health outcomes under the State MFP demonstration
projects.
``(E) State strategies and financing mechanisms for
effective coordination of housing financed or supported
under State MFP demonstration projects with local
housing authorities and other resources.
``(F) Effective State approaches for delivering
Money Follows the Person transition services through
managed care entities.
``(G) Other best practices and effective transition
strategies demonstrated by States with approved MFP
demonstration projects, as determined by the Secretary.
``(H) Identification and analyses of opportunities
and challenges to integrating effective Money Follows
the Person practices and State strategies into the
traditional Medicaid program.
``(2) Collaboration.--In preparing the report required
under this subsection, the Secretary shall collect and
incorporate information from States with approved MFP
demonstration projects and beneficiaries participating in such
projects, and providers participating in such projects.
``(3) Funding.--From the amounts appropriated under
subsection (h)(1) for each of fiscal years 2020 and 2021, not
more than $300,000 shall be available to the Secretary for each
such fiscal year to carry out this subsection.''.
(f) MACPAC Report on Qualified Settings Criteria.--Section 6071 of
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note), as amended by
subsection (e), is further amended by adding at the end the following:
``(j) MACPAC Report.--Prior to the final implementation date
established by the Secretary for the criteria established for home and
community-based settings in section 441.301(c)(4) of title 42, Code of
Federal Regulations, as part of final implementation of the Home and
Community Based Services (HCBS) Final Rule published on January 16,
2014 (79 Fed. Reg. 2947) (referred to in this subsection as the `HCBS
final rule'), the Medicaid and CHIP Payment and Access Commission
(MACPAC) shall submit to Congress a report that--
``(1) identifies the types of home and community-based
settings and associated services that are available to eligible
individuals in both the MFP demonstration program and sites in
compliance with the HCBS final rule; and
``(2) if determined appropriate by the Commission,
recommends policies to align the criteria for a qualified
residence under subsection (b)(6) (as in effect on October 1,
2017) with the criteria in the HCBS final rule.''.
(g) Application to Current Projects.--Not later than 1 year after
the date of the enactment of this Act, any State with an approved MFP
demonstration project under section 6071 of the Deficit Reduction Act
of 2005 (42 U.S.C. 1396a note) on the date of the enactment of this Act
shall submit a revised application to the Secretary that contains the
same information and assurances as are required for any new State
applicant under the amendments made by this section.
SEC. 3. CLARIFYING AUTHORITY OF STATE MEDICAID FRAUD AND ABUSE CONTROL
UNITS TO INVESTIGATE AND PROSECUTE CASES OF MEDICAID
PATIENT ABUSE AND NEGLECT IN ANY SETTING.
(a) In General.--Section 1903(q)(4)(A)(ii) of the Social Security
Act (42 U.S.C. 1396b(q)(4)(A)(ii)) is amended by inserting after
``patients residing in board and care facilities'' the following: ``and
of patients (who are receiving medical assistance under the State plan
under this title) in a noninstitutional or other setting''.
(b) Availability of Funding.--Section 1903(a)(6) of the Social
Security Act (42 U.S.C. 1396b(a)(6)) is amended, in the matter
following subparagraph (B), by striking ``(as found necessary by the
Secretary for the elimination of fraud in the provision and
administration of medical assistance provided under the State plan)''.
SEC. 4. EXTENSION OF PROTECTION FOR MEDICAID RECIPIENTS OF HOME AND
COMMUNITY-BASED SERVICES AGAINST SPOUSAL IMPOVERISHMENT.
(a) In General.--Section 2404 of Public Law 111-148 (42 U.S.C.
1396r-5 note) is amended by striking ``September 30, 2019'' and
inserting ``March 31, 2024''.
(b) Rule of Construction.--Nothing in section 2404 of Public Law
111-148 (42 U.S.C. 1396r-5 note), section 1924 of the Social Security
Act (42 U.S.C. 1396r-5), or section 1902(a)(17) of such Act (42 U.S.C.
1396a(a)(17)) shall be construed as prohibiting a State from applying
an income or resource disregard authorized under section 1902(r)(2) of
such Act (42 U.S.C. 1396a(r)(2))--
(1) to the income or resources of individuals described in
section 1902(a)(10)(A)(ii)(VI) of such Act (42 U.S.C.
1396a(a)(10)(A)(ii)(VI)) (including a disregard of the income
or resources of such individual's spouse); or
(2) on the basis of an individual's need for home and
community-based services authorized under subsection (c), (d),
(i), or (k) of section 1915 of such Act (42 U.S.C. 1396n) or
under section 1115 of such Act (42 U.S.C. 1315).
SEC. 5. EXTENSION OF THE COMMUNITY MENTAL HEALTH SERVICES DEMONSTRATION
PROGRAM.
Section 223(d) of the Protecting Access to Medicare Act of 2014 (42
U.S.C. 1396a note) is amended--
(1) in paragraph (3), by striking ``June 30, 2019'' and
inserting ``December 31, 2021''; and
(2) in paragraph (7)(B), by striking ``December 31, 2021''
and inserting ``June 30, 2021''.
SEC. 6. PREVENTING INAPPROPRIATELY LOW REBATES UNDER MEDICAID DRUG
REBATE PROGRAM.
(a) Prohibiting Manufacturers From Blending Average Manufacturer
Price of Brand Drug and Any Authorized Generic of Such Drug.--Section
1927(k)(1)(C) of the Social Security Act (42 U.S.C. 1396r-8(k)(1)(C))
is amended--
(1) in the subparagraph heading, by striking ``Inclusion''
and inserting ``Exclusion'';
(2) by striking ``a new drug application'' and inserting
``the manufacturer's new drug application''; and
(3) by striking ``inclusive'' and inserting ``exclusive''.
(b) Eliminating Manufacturers From Definition of Wholesaler.--
Section 1927(k)(11) of the Social Security Act (42 U.S.C. 1396r-
8(k)(11)) is amended--
(1) by striking ``manufacturers,''; and
(2) by striking ``manufacturer's and''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to covered outpatient drugs dispensed on or after
January 1, 2020.
SEC. 7. MEDICAID IMPROVEMENT FUND.
Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w-
1(b)(1)) is amended by striking ``$6,000,000'' and inserting
``$45,500,000''.
SEC. 8. DETERMINATION OF BUDGETARY EFFECTS.
The budgetary effects of this Act, for the purpose of complying
with the Statutory Pay-As-You-Go Act of 2010, shall be determined by
reference to the latest statement titled ``Budgetary Effects of PAYGO
Legislation'' for this Act, submitted for printing in the Congressional
Record by the Chairman of the House Budget Committee, provided that
such statement has been submitted prior to the vote on passage.
Passed the House of Representatives June 18, 2019.
Attest:
CHERYL L. JOHNSON,
Clerk.