[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3371 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 3371
To amend titles XI and XIX of the Social Security Act to stabilize the
Medicaid program in Puerto Rico.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 19, 2019
Ms. Velazquez (for herself, Mr. Soto, Mr. Serrano, Mr. Grijalva, Mr.
Espaillat, Ms. Ocasio-Cortez, Mr. Garcia of Illinois, and Miss
Gonzalez-Colon of Puerto Rico) introduced the following bill; which was
referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend titles XI and XIX of the Social Security Act to stabilize the
Medicaid program in Puerto Rico.
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 ``Puerto Rico Health Care Fairness,
Accountability, and Beneficiary Access Act of 2019''.
SEC. 2. ADJUSTMENTS TO FMAP AND CAP FOR PUERTO RICO.
(a) Adjustments to FMAP.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended--
(1) in subsection (b)--
(A) by striking ``for Puerto Rico, the Virgin
Islands'' and inserting ``for the Virgin Islands''; and
(B) by striking ``and American Samoa shall be 55
percent,'' and inserting ``and America Samoa (and, for
calendar quarters in a fiscal year before fiscal year
2020, Puerto Rico) shall be 55 percent, and for Puerto
Rico, for calendar quarters in a fiscal year beginning
with fiscal year 2020, shall be the PR specified
percent under subsection (ff) for such fiscal year,'';
and
(2) by adding at the end the following new subsection:
``(ff)(1) For purposes of subsection (b), the PR specified percent
under this subsection is--
``(A) subject to paragraph (2), for each of fiscal years
2020 through 2024, 83 percent;
``(B) subject to paragraph (3)(D)(iii), for each of fiscal
years 2025 through 2029, 83 percent; and
``(C) subject to paragraph (3)(D)(iii), for fiscal year
2030 and each subsequent fiscal year, the Federal medical
assistance percentage calculated in accordance with the first
sentence of subsection (b), as such sentence applies to the 50
States.
``(2)(A) If Puerto Rico--
``(i) for fiscal year 2021, is in compliance with none of
the program enhancement requirements described in subparagraph
(B), the PR specified percent specified under paragraph (1) for
such fiscal year shall be reduced by 2 percent;
``(ii) for fiscal year 2022, is in compliance with fewer
than two of the four program enhancement requirements described
in subparagraph (B), the PR specified percent specified under
paragraph (1) for such fiscal year shall be reduced by 3
percent;
``(iii) for fiscal year 2023, is in compliance with fewer
than three of the four program enhancement requirements
described in subparagraph (B), the PR specified percent
specified under paragraph (1) for such fiscal year shall be
reduced by 5 percent; and
``(iv) for fiscal year 2024, is in compliance with fewer
than four of the program enhancement requirements described in
subparagraph (B), the PR specified percent specified under
paragraph (1) for such fiscal year shall be reduced by 5
percent.
``(B) For purposes of this subsection, the program enhancement
requirements described in this subparagraph are each of the following:
``(i) Rates of payment under the State plan under this
title for inpatient hospital services are not less than the
costs incurred for such services.
``(ii) Rates of payment under the State plan under this
title for physicians' services are not less than 70 percent of
the amount that is payable for such services under section
1848.
``(iii) The State plan provides for medical assistance for
Hepatitis C drugs, in accordance with the requirements of
section 1927 otherwise applicable to the 50 States.
``(iv) The State plan provides for medical assistance for
Medicare cost-sharing described in subsection (p)(3)(A)(ii) for
qualified Medicare beneficiaries described in subsection
(p)(1), in accordance with the requirements under subsection
(p) otherwise applicable to the 50 States.
``(3)(A)(i) Not later than January 1, 2022, the Governor of Puerto
Rico shall submit to the Secretary a Territory Transition Plan, which
shall be developed with stakeholder input and with a public comment
period, that includes--
``(I) a detailed description of which program
enhancements described in subparagraph (C) Puerto Rico
will include as medical assistance under the State plan
under title XIX, the first plan year by which each such
program enhancement will be so included in order to
satisfy the requirements described in subparagraph (B),
and a timeline for milestones for including such
program enhancements; and
``(II) a description of any challenges, including
infrastructure challenges, provider shortages, and
financing challenges, for so including such program
enhancements and a plan to ameliorate any such
challenges.
``(ii) The plan submitted under clause (i) shall be treated as
approved by the Secretary not later than 180 days after the date of
submission of the plan unless within such 180-day period the Secretary
disapproves such plan and notifies Puerto Rico of such disapproval with
the reason for such disapproval. In the case of such a disapproval, the
Governor of Puerto Rico shall, within the 90-day period following such
notification, submit to the Secretary a Territory Transition Plan that
addresses the reason specified in such notification for such
disapproval. Such resubmitted plan shall be treated as approved by the
Secretary under this clause unless the Secretary notifies Puerto Rico
within the 30-day period following such submission of its disapproval
with a reason for such disapproval. The Governor of Puerto Rico may
develop and submit to the Secretary, in the same manner and subject to
the same conditions as apply under clause (i) to the development and
submission of the Territory Transition Plan, modifications to the plan
and such modifications shall be treated as approved by the Secretary
and incorporated into the plan in the same manner and subject to the
same conditions that apply under this clause to the approval of the
plan.
``(B) For purposes of this paragraph, the requirements described in
this subparagraph, with respect to Puerto Rico, are the following:
``(i) For 2027, the State plan under title XIX includes at
least 2 of the program enhancements described in subparagraph
(C).
``(ii) For 2029, the State plan includes at least 4 of such
program enhancements.
``(iii) For 2031, the State plan includes at least 6 of
such program enhancements.
``(iv) For 2033 and each subsequent year, the State plan
includes all of such program enhancements.
``(C) For purposes of this paragraph, the program enhancements
described in this subparagraph are the following:
``(i) The State plan provides for medical assistance to all
individuals described in clause (i) of section 1902(a)(10)(A)).
``(ii) The State plan provides for inclusion as medical
assistance of home health services, in accordance with section
1902(a)(10)(D).
``(iii) The State plan provides for inclusion as medical
assistance of nonemergency transportation to medically
necessary services.
``(iv) The State plan provides for inclusion as medical
assistance of services described in subsection (a)(21) to all
individuals described in clause (i) of section 1902(a)(10)(A)).
``(v) The State plan provides for inclusion as medical
assistance of services described in subsection (a)(17) to all
individuals described in such clause (other than subclause
(VIII) of such clause.
``(vi) The State plan provides for inclusion as medical
assistance of nursing facility services, as defined in
subsection (a)(4)(A).
``(vii) The State plan provides for inclusion as medical
assistance of early and periodic screening, diagnosis, and
treatment services under subsection (a)(4)(B).
``(viii) The State plan provides for inclusion as medical
assistance of freestanding birth center services and other
ambulatory services, as described in subsection (a)(28).
``(D)(i) For fiscal year 2022 and each subsequent fiscal year
through fiscal year 2033--
``(I) the Comptroller General of the United States shall
review, and submit to the Secretary and Congress a report on,
whether or not Puerto Rico is in compliance with the timeline
and achieving the milestones described in the Territory
Transition plan (as modified, if applicable) approved under
subparagraph (A) and, beginning with fiscal year 2027, whether
Puerto Rico is in compliance with the applicable requirements
described in subparagraph (B); and
``(II) Puerto Rico shall submit to the Secretary a report
on the extent to which Puerto Rico has met the timelines and
milestones included in such plan (as modified, if applicable).
``(ii) If, for a fiscal year described in clause (i) after fiscal
year 2024, the Comptroller General submits a report with a finding that
Puerto Rico is not in compliance with the timeline or with achieving
milestones as described in subclause (I) (or, with respect to a fiscal
year after fiscal year 2026, not in compliance with the applicable
requirement under subparagraph (B)), not later than 90 days after the
date of such finding, Puerto Rico shall submit to the Secretary for
approval a corrective action plan to remedy such noncompliance.
``(iii) If, by not later than a period specified by the Secretary
after the date of the submission (and approval) of a corrective action
plan under clause (ii), with respect to a fiscal year after fiscal year
2024 for which a finding of non-compliance was made under clause (i),
the Secretary determines that Puerto Rico has not fulfilled the terms
of such corrective action plan, the PR specified percent specified
under paragraph (1) for the fiscal year involved shall be reduced by 5
percent for the period beginning with the month beginning after such
determination and ending with the first month beginning after the
Secretary determines Puerto Rico has fulfilled the terms of the
corrective action plan.''.
(b) Treatment of Cap.--Section 1108(g) of the Social Security Act
(42 U.S.C. 1308(g)) is amended--
(1) in paragraph (2)--
(A) in the matter preceding subparagraph (A), by
striking ``subject to and section 1323(a)(2) of the
Patient Protection and Affordable Care Act paragraphs
(3) and (5)'' and inserting ``subject to section
1323(a)(2) of the Patient Protection and Affordable
Care Act and paragraphs (3), (5), and (7)''; and
(B) in subparagraph (A)--
(i) by striking ``Puerto Rico shall not
exceed the sum of'' and inserting ``Puerto Rico
shall not exceed--
``(i) in the case of a fiscal year before
fiscal year 2020, the sum of'';
(ii) by striking ``$100,000;'' and
inserting ``$100,000; and''; and
(iii) by adding at the end the following
new clause:
``(ii) in the case of fiscal year 2020 and
each subsequent fiscal year (before fiscal year
2025), the amount specified in paragraph (6)
for such fiscal year;''; and
(2) by adding at the end the following new paragraphs:
``(6) Application to puerto rico for fiscal years 2020
through 2024.--For purposes of paragraph (2)(A)(ii), the amount
specified in this paragraph is--
``(A) for fiscal year 2020, $2,823,188,000;
``(B) for fiscal year 2021, $2,919,072,000;
``(C) for fiscal year 2022, $3,012,610,000;
``(D) for fiscal year 2023, $3,114,331,000; and
``(E) for fiscal year 2024, $3,225,627,000.
``(7) Puerto rico exclusion from payment limitation
beginning fiscal year 2025.--Beginning with fiscal year 2025,
there shall be no limitation applied under this subsection (f)
or this subsection on the total amount certified by the
Secretary under title XIX for payment to Puerto Rico.''.
(c) Temporary Increase in Federal Match for State Plan
Administrative Costs.--Section 1903(a)(7) of the Social Security Act
(42 U.S.C. 1396b(a)(7)) is amended by inserting ``(or, in the case of
Puerto Rico for each of fiscal years 2020 through 2033, 100 percent)''
after ``50 per centum''.
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