[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3120 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  1st Session
                                S. 3120

To provide Medicaid assistance to individuals and families affected by 
            a disaster or emergency, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 24, 2023

Mr. Casey (for himself, Mr. Blumenthal, Mr. Welch, Mr. Van Hollen, Mrs. 
  Gillibrand, Ms. Warren, Mr. Brown, Mr. Sanders, Mr. Fetterman, Mr. 
  Schatz, and Ms. Duckworth) introduced the following bill; which was 
          read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To provide Medicaid assistance to individuals and families affected by 
            a disaster or emergency, 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.

    This Act may be cited as the ``Disaster Relief Medicaid Act''.

SEC. 2. MEDICAID RELIEF FOR DISASTER SURVIVORS.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended--
            (1) in section 1902(a)--
                    (A) in paragraph (86), by striking ``; and'' and 
                inserting a semicolon;
                    (B) in paragraph (87), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by inserting after paragraph (87) the following 
                new paragraph:
            ``(88) beginning January 1, 2025, provide for making 
        medical assistance available to relief-eligible survivors of 
        disasters during relief coverage periods in accordance with 
        section 1948.''; and
            (2) by adding at the end the following new section:

``SEC. 1948. DISASTER RELIEF MEDICAID FOR SURVIVORS OF MAJOR DISASTERS.

    ``(a) In General.--Notwithstanding any other provision of this 
title, a State plan shall provide medical assistance to a relief-
eligible survivor of a disaster in accordance with this section.
    ``(b) Definitions.--In this section:
            ``(1) Disaster.--The term `disaster' means any of the 
        following:
                    ``(A) A major disaster that is declared on or after 
                January 1, 2025, by the President in accordance with 
                section 401 of the Robert T. Stafford Disaster Relief 
                and Emergency Assistance Act (42 U.S.C. 5170) and which 
                the President has determined warrants individual or 
                public assistance from the Federal Government under 
                such Act.
                    ``(B) A national emergency declared by the 
                President under the National Emergencies Act (50 U.S.C. 
                1601 et seq.).
                    ``(C) A public health emergency declared by the 
                Secretary pursuant to section 319 of the Public Health 
                Service Act (42 U.S.C. 247d).
            ``(2) Direct impact area.--
                    ``(A) In general.--The term `direct impact area' 
                means, with respect to a disaster, the geographic area 
                in which the disaster exists.
                    ``(B) Website posting of direct impact areas.--As 
                soon as practicable after a disaster is declared (as 
                described in subparagraph (A), (B), or (C) of paragraph 
                (1), as applicable), the Secretary shall post on the 
                websites of the Centers for Medicare & Medicaid 
                Services and the Federal Emergency Management Agency a 
                list of the areas identified as the direct impact areas 
                of the disaster.
            ``(3) Home state.--The term `home State' means, with 
        respect to a survivor of a disaster, the State in which the 
        survivor was a resident (as determined in accordance with 
        section 435.403 of title 42, Code of Federal Regulations (or 
        any successor regulation)) on the date on which the disaster is 
        declared (as described in subparagraph (A), (B), or (C) of 
        paragraph (1), as applicable).
            ``(4) Relief coverage period.--The term `relief coverage 
        period' means, with respect to a disaster, the period that 
        begins on the date the disaster is declared (as described in 
        subparagraph (A), (B), or (C) of paragraph (1), as applicable) 
        and ends on the day that is 2 years after such date.
            ``(5) Relief-eligible survivor.--
                    ``(A) In general.--Subject to subparagraph (C), the 
                term `relief-eligible survivor' means an individual who 
                is a survivor of a disaster whose family income does 
                not exceed the higher of--
                            ``(i) 133 percent (or, in the case of a 
                        survivor who is a pregnant individual, a child, 
                        or a recipient of benefits under title II on 
                        the basis of a disability, 200 percent) of the 
                        poverty line; or
                            ``(ii) the income eligibility standard that 
                        would otherwise apply to the survivor under the 
                        State plan of the survivor's home State (or a 
                        waiver of such plan).
                    ``(B) Disregard of unemployment income and fema 
                individual assistance grants.--For purposes of this 
                section, and notwithstanding section 1902(e)(14)(B), 
                the income of a survivor of a disaster shall not 
                include--
                            ``(i) any amount received by the survivor 
                        during the relief coverage period of the 
                        disaster under a law of the United States or a 
                        State which is in the nature of unemployment 
                        compensation; or
                            ``(ii) any amount received during the 
                        relief coverage period of the disaster by the 
                        survivor (or the survivor's household) as 
                        assistance under a program administered by the 
                        Federal Emergency Management Agency.
                    ``(C) Limitation to relief coverage period.--
                            ``(i) In general.--Except as provided in 
                        clauses (ii) and (iii), for purposes of this 
                        section, an individual shall not be considered 
                        to be a relief-eligible survivor on the basis 
                        of the individual's status as a survivor of a 
                        disaster after the end of the relief coverage 
                        period of the disaster.
                            ``(ii) Continuous eligibility for disaster 
                        relief coverage for pregnant and postpartum 
                        individuals.--In the case of an individual who, 
                        while pregnant, receives medical assistance as 
                        a relief-eligible survivor of a disaster under 
                        a State plan (or a waiver of such a plan) in 
                        accordance with this section, such individual 
                        shall continue to be eligible for medical 
                        assistance as a relief-eligible survivor 
                        through the end of the month in which the 60-
                        day period (beginning on the last day of the 
                        pregnancy) (or, if longer, the period of 
                        postpartum continuous eligibility that 
                        otherwise applies to individuals who, while 
                        pregnant, are eligible for medical assistance 
                        under the State plan or waiver) ends, without 
                        regard to whether the pregnancy ends before or 
                        after the end of the relief coverage period of 
                        the disaster.
                            ``(iii) Continuous eligibility for 
                        individuals with pending applications.--If an 
                        individual who receives medical assistance as a 
                        relief-eligible survivor of a disaster under a 
                        State plan (or a waiver of such a plan) in 
                        accordance with this section has an application 
                        pending for medical assistance under the State 
                        plan (or waiver) under this title or for child 
                        health assistance or pregnancy-related 
                        assistance under a State plan under title XXI 
                        (or a waiver of such a plan) on the date that 
                        the relief coverage period of the disaster 
                        ends, such individual shall continue to be 
                        eligible for medical assistance as a relief-
                        eligible survivor through the earlier of--
                                    ``(I) the end of the month in which 
                                the 60-day period (beginning on the 
                                last day of such relief coverage 
                                period) ends; and
                                    ``(II) the date on which the 
                                individual's application for medical 
                                assistance, child health assistance, or 
                                pregnancy-related assistance (as 
                                applicable) is approved or denied.
            ``(6) Survivor.--
                    ``(A) In general.--The term `survivor' means, with 
                respect to a disaster, an individual who is described 
                in subparagraph (B) or (C).
                    ``(B) Residents and evacuees of direct impact 
                areas.--An individual described in this subparagraph is 
                an individual who, on the date on which a disaster is 
                declared (as described in subparagraph (A), (B), or (C) 
                of paragraph (1), as applicable), has a primary 
                residence in the disaster's direct impact area.
                    ``(C) Individuals who lost employment.--An 
                individual described in this subparagraph is an 
                individual--
                            ``(i) whose worksite was located in the 
                        disaster's direct impact area;
                            ``(ii) who was employed by an employer 
                        that--
                                    ``(I) conducted an active trade or 
                                business in such area on the date on 
                                which the disaster was declared (as so 
                                described); and
                                    ``(II) was unable to operate such 
                                trade or business as a result of the 
                                disaster on any day during the 
                                disaster's relief coverage period; and
                            ``(iii) whose employment with such employer 
                        was terminated.
                    ``(D) Treatment of homeless persons.--In the case 
                of an individual who is homeless (as such term is 
                defined in section 103(a) of the McKinney-Vento 
                Homeless Assistance Act (42 U.S.C. 11302(a))) on the 
                date on which a disaster is declared (as so described), 
                the individual's residency for purposes of subparagraph 
                (B) shall be determined in accordance with section 
                435.403 of title 42, Code of Federal Regulations (or 
                any successor regulation).
                    ``(E) Effect of concurrent eligibility for medicaid 
                or chip.--An individual's eligibility for medical 
                assistance under a State plan (or waiver of such plan) 
                (or for child health assistance or pregnancy-related 
                assistance under a State plan under title XXI (or a 
                waiver of such a plan)) on a basis other than under 
                this section shall not prevent the individual from 
                being treated as a survivor under this section, and the 
                rights afforded to an individual who is eligible for or 
                enrolled under a State plan (or waiver) under either 
                such title shall not be affected by the individual's 
                receipt of medical assistance as a relief-eligible 
                survivor of a disaster in accordance with this section.
    ``(c) Eligibility.--
            ``(1) Simplified application.--
                    ``(A) In general.--For purposes of determining 
                eligibility for medical assistance under this section, 
                each State may accept a simplified, streamlined 
                application form (as developed by the Secretary in 
                consultation with the National Association of State 
                Medicaid Directors), which shall--
                            ``(i) require an applicant for medical 
                        assistance in accordance with this section as a 
                        survivor of a disaster to--
                                    ``(I) provide the applicant's 
                                mailing address for the duration of the 
                                relief coverage period of the disaster; 
                                and
                                    ``(II) agree to update the 
                                information described in subclause (I) 
                                if it changes during such period;
                            ``(ii) provide notice of the penalties for 
                        making a fraudulent application described in 
                        subsection (g);
                            ``(iii) require the applicant to assign to 
                        the State any rights of the applicant (or any 
                        other individual who is a relief-eligible 
                        survivor and on whose behalf the applicant has 
                        the legal authority to execute an assignment of 
                        such rights) as described and in accordance 
                        with the requirements of section 1912;
                            ``(iv) require the applicant to list any 
                        health insurance coverage in which the 
                        applicant was enrolled immediately prior to 
                        submitting the application for medical 
                        assistance under this section; and
                            ``(v) require the applicant to self-attest 
                        that the applicant--
                                    ``(I) is a relief-eligible survivor 
                                of the disaster; and
                                    ``(II) if applicable, requires home 
                                and community-based services.
                    ``(B) No documentation requirement.--
                            ``(i) In general.--A State shall not 
                        require an applicant for medical assistance as 
                        a survivor of a disaster under this section to 
                        provide any documentation or other evidence--
                                    ``(I) of the applicant's status as 
                                a relief-eligible survivor; and
                                    ``(II) if applicable, that the 
                                applicant requires home and community-
                                based services.
                            ``(ii) Use of available electronic data 
                        sources.--In making determinations with respect 
                        to the status of an applicant for medical 
                        assistance as a survivor of a disaster under 
                        this section, or such an applicant's need for 
                        home and community-based services, a State may 
                        use data relating to the applicant that is 
                        available to the State from electronic data 
                        sources.
            ``(2) Presumptive eligibility for relief-eligible 
        survivors.--
                    ``(A) In general.--A State shall provide for making 
                medical assistance available to an individual as a 
                relief-eligible survivor under this section during a 
                presumptive eligibility period.
                    ``(B) Presumptive eligibility period defined.--For 
                purposes of this paragraph--
                            ``(i) the term `presumptive eligibility 
                        period' means, with respect to an individual, 
                        the period that--
                                    ``(I) begins with the date on which 
                                a qualified provider determines, on the 
                                basis of preliminary information, that 
                                the individual satisfies the criteria 
                                for eligibility for medical assistance 
                                as a relief-eligible survivor under 
                                this section; and
                                    ``(II) ends with (and includes) the 
                                earlier of--
                                            ``(aa) the day on which a 
                                        determination is made with 
                                        respect to the eligibility of 
                                        the individual for medical 
                                        assistance as a relief-eligible 
                                        survivor under this section; or
                                            ``(bb) in the case of an 
                                        individual who does not file an 
                                        application by the last day of 
                                        the month following the month 
                                        during which the provider makes 
                                        the determination referred to 
                                        in item (aa), such last day; 
                                        and
                            ``(ii) the term `qualified provider' has 
                        the meaning given such term in section 1920.
                    ``(C) Coordination between state agencies and 
                qualified providers.--
                            ``(i) Provision of forms and information to 
                        qualified providers.--The State agency shall 
                        provide qualified providers with--
                                    ``(I) such forms as are necessary 
                                for an individual to make application 
                                for medical assistance under the State 
                                plan as a relief-eligible survivor; and
                                    ``(II) information on how to assist 
                                individuals and their authorized 
                                representatives in completing and 
                                filing such forms.
                            ``(ii) Provision of notice of 
                        determinations to state agencies.--A qualified 
                        provider that determines under this 
                        subparagraph that an individual is eligible for 
                        medical assistance under a State plan as a 
                        relief-eligible survivor under this section 
                        shall--
                                    ``(I) notify the State agency of 
                                the determination within 5 working days 
                                after the date on which determination 
                                is made; and
                                    ``(II) inform the individual at the 
                                time the determination is made that the 
                                individual is required to make 
                                application for medical assistance 
                                under the State plan by not later than 
                                the last day of the month following the 
                                month during which the determination is 
                                made.
                    ``(D) Application requirement.--An individual who 
                is determined by a qualified provider to be 
                presumptively eligible as a relief-eligible survivor 
                for medical assistance under a State plan shall make 
                application for medical assistance under such plan by 
                not later than the last day of the month following the 
                month during which the determination is made, which 
                application may be the streamlined application 
                described in paragraph (1).
                    ``(E) Treatment as medical assistance.--
                Notwithstanding any other provision of this title, 
                items and services that are--
                            ``(i) furnished to an individual during a 
                        presumptive eligibility period under this 
                        paragraph by a provider that is eligible for 
                        payments under the State plan; and
                            ``(ii) included in the care and services 
                        covered by the State plan;
                shall be treated as medical assistance provided to a 
                relief-eligible survivor of a disaster during the 
                relief coverage period of the disaster under this 
                section.
            ``(3) Continuous eligibility.--
                    ``(A) In general.--Subject to subparagraph (B), an 
                individual who is determined by a State to be a relief-
                eligible survivor of a disaster shall remain eligible 
                for medical assistance under the State plan (or a 
                waiver of such plan) as such a survivor, without the 
                need for any redetermination of eligibility, for the 
                duration of the relief coverage period of the disaster.
                    ``(B) Exceptions.--A State may terminate the 
                eligibility of an individual who is determined by a 
                State to be a relief-eligible survivor of a disaster 
                before the end of the relief coverage period of the 
                disaster if--
                            ``(i) the individual (or the individual's 
                        authorized representative) requests a voluntary 
                        termination of eligibility;
                            ``(ii) the individual ceases to be a 
                        resident of the State;
                            ``(iii) the State determines that 
                        eligibility was erroneously granted because of 
                        State error or fraud, abuse, or perjury 
                        attributed to the individual (or the 
                        individual's authorized representative); or
                            ``(iv) the individual dies.
            ``(4) Issuance of disaster relief medicaid eligibility 
        card.--A State shall issue a disaster relief Medicaid 
        eligibility card to each applicant who is determined to be a 
        relief-eligible survivor of a disaster and eligible for medical 
        assistance under this section, which shall be valid for the 
        duration of the relief coverage period of the disaster.
            ``(5) Verification of status as a relief-eligible 
        survivor.--
                    ``(A) In general.--The State shall make a good 
                faith effort to verify the status of an individual who 
                is enrolled in the State plan (or a waiver of such 
                plan) as a relief-eligible survivor of a disaster in 
                accordance with this section. Such effort shall not 
                delay the determination of the eligibility of the 
                individual for medical assistance under this section, 
                and a State may enroll an individual in the State plan 
                or waiver under this section pending such verification.
                    ``(B) Evidence of verification.--A State may 
                satisfy the verification requirement under subparagraph 
                (A) with respect to an individual by showing that the 
                State obtained information from the Social Security 
                Administration, the Internal Revenue Service, or, if 
                applicable, the State Medicaid agency of the home State 
                of the individual.
            ``(6) Determination by express lane agency.--Any 
        determination or redetermination of eligibility or verification 
        of status made under this section shall be made by an Express 
        Lane agency (as defined in section 1902(e)(13)(F)).
    ``(d) Scope of Coverage.--
            ``(1) In general.--A State providing medical assistance to 
        a relief-eligible survivor of a disaster in accordance with 
        this section shall provide medical assistance that is at least 
        equal in amount and scope to the medical assistance that would 
        otherwise be made available to such survivor if the survivor 
        were enrolled in the State plan (or waiver of such plan) as an 
        individual described in clause (i) of section 1902(a)(10)(A), 
        except that, in the case of such a survivor whose home State is 
        not the State providing medical assistance to the individual, 
        the State shall also provide medical assistance for any item or 
        service for which medical assistance is available to 
        individuals described in clause (i) of section 1902(a)(10)(A) 
        under the State plan (or waiver) of the survivor's home State.
            ``(2) Provider payment rates for home state services.--In 
        the case of medical assistance provided under this section by a 
        State to a relief-eligible survivor of a disaster whose home 
        State is not the State providing such assistance for an item or 
        service which is not otherwise available under the State plan 
        (or waiver of such plan) but which is available under the State 
        plan (or waiver) of the survivor's home State, the State shall 
        pay the provider of such item or service at least at the same 
        rate that the home State would pay for the item or service if 
        it were provided under the plan or waiver of the home State 
        (or, if no such payment rate applies under the plan or waiver 
        of the home State, the usual and customary prevailing rate for 
        the item or service for the community in which it is provided).
            ``(3) Retroactive coverage.--
                    ``(A) In general.--Notwithstanding section 1905(a), 
                a State shall provide medical assistance for items and 
                services furnished in the State beginning with the 
                first day of the relief coverage period of a disaster 
                to any relief-eligible survivor of the disaster who 
                submits an application for such assistance before the 
                deadline described in subparagraph (B).
                    ``(B) Application deadline.--The deadline for a 
                relief-eligible survivor of a disaster to submit an 
                application for medical assistance in accordance with 
                this section is the date that is 90 days after the end 
                of the disaster's relief coverage period.
            ``(4) Children born to relief-eligible survivors of a 
        disaster.--In the case of a child born to a relief-eligible 
        survivor of a disaster who is provided medical assistance in 
        accordance with this section during the relief coverage period 
        of the disaster, the child shall be treated as having been born 
        to a pregnant individual eligible for medical assistance under 
        the State plan (or waiver of such plan) and shall be eligible 
        for medical assistance under such plan (or waiver) in 
        accordance with section 1902(e)(4). Notwithstanding subsection 
        (f), the Federal medical assistance percentage determined for a 
        State and fiscal year under section 1905(b) shall apply to 
        medical assistance provided during the year to a child under 
        the State plan (or waiver) in accordance with the preceding 
        sentence.
            ``(5) Option to provide extended mental health and care 
        coordination benefits.--A State may provide, without regard to 
        any restrictions on amount, duration, scope, or comparability, 
        or other restrictions under this title or the State plan or 
        waiver of such plan (other than restrictions applicable to 
        services provided in an institution for mental diseases), 
        medical assistance to relief-eligible survivors of a disaster 
        under this section for extended mental health and care 
        coordination services, which may include the following:
                    ``(A) Screening, assessment, and diagnostic 
                services (including specialized assessments for 
                individuals with cognitive impairments).
                    ``(B) Coverage for a full range of mental health 
                medications at the dosages and frequencies prescribed 
                by health professionals for depression, post-traumatic 
                stress disorder, and other mental disorders.
                    ``(C) Treatment of alcohol and substance abuse 
                determined to result from circumstances related to the 
                disaster.
                    ``(D) Psychotherapy, rehabilitation and other 
                treatments administered by psychiatrists, 
                psychologists, social workers, or other qualified 
                mental or behavioral health professionals for 
                conditions exacerbated by, or resulting from, the 
                disaster.
                    ``(E) Peer support services related to the 
                disaster.
                    ``(F) Mobile crisis services to assist with crises 
                related to the disaster.
                    ``(G) Inpatient and outpatient mental health care.
                    ``(H) Family counseling for families where a member 
                of the immediate family is a survivor of the disaster 
                or a first responder to the disaster or includes an 
                individual who has died as a result of the disaster.
                    ``(I) In connection with the provision of health 
                and long-term care services, arranging for, (and when 
                necessary, enrollment in waiver programs or other 
                specialized programs), and coordination related to, 
                primary and specialty medical care, which may include 
                personal care services, durable medical equipment and 
                supplies, assistive technology, and transportation.
            ``(6) Option to provide home and community-based 
        services.--
                    ``(A) In general.--A State may provide medical 
                assistance under this section for home and community-
                based services to a relief-eligible survivor of a 
                disaster, including any survivor who is an individual 
                described in subparagraph (B), who self-attests that 
                the survivor immediately requires such services, 
                without regard to whether the survivor would require 
                the level of care provided in a hospital, nursing 
                facility, or intermediate care facility for the 
                developmentally disabled.
                    ``(B) Individuals described.--Individuals described 
                in this subparagraph are relief-eligible survivors of a 
                disaster who--
                            ``(i) on any day during the week preceding 
                        the date on which the disaster is declared (as 
                        described in subparagraph (A), (B), or (C) of 
                        subsection (b)(1), as applicable)--
                                    ``(I) had been receiving home and 
                                community-based services in a direct 
                                impact area under a waiver under 
                                section 1115 or section 1915;
                                    ``(II) had been receiving support 
                                services from a family caregiver who, 
                                as a result of the disaster, is no 
                                longer available to provide services; 
                                or
                                    ``(III) had been receiving personal 
                                care, home health, or rehabilitative 
                                services under a State plan under this 
                                title or under a waiver granted under 
                                sections 1115 or 1915; or
                            ``(ii) are disabled (as determined in 
                        accordance with the State plan of the home 
                        State of the individual).
                    ``(C) Waiver of restrictions.--With respect to the 
                provision of home and community-based services under 
                this paragraph, the Secretary--
                            ``(i) shall waive any limitations on--
                                    ``(I) the number of individuals who 
                                may receive home or community-based 
                                services under a waiver described in 
                                subparagraph (B)(i)(I);
                                    ``(II) budget neutrality 
                                requirements applicable to such waiver; 
                                and
                                    ``(III) populations eligible for 
                                services under such waiver; and
                            ``(ii) may waive any other restriction 
                        applicable under such a waiver that would 
                        prevent a State from providing home and 
                        community-based services in accordance with 
                        this paragraph.
    ``(e) State Reports.--Each State shall submit to the Secretary an 
annual report that includes--
            ``(1) the number of survivors of a disaster who were 
        determined by the State to be relief-eligible survivors of a 
        disaster in the preceding year; and
            ``(2) the number of relief-eligible survivors of a disaster 
        who were determined to be eligible for, and enrolled in, the 
        State plan (or waiver of such plan) or the State child health 
        plan under title XXI (or waiver of such plan) other than under 
        this section.
    ``(f) 100 Percent Federal Matching Payments.--
            ``(1) In general.--Notwithstanding section 1905(b), the 
        Federal medical assistance percentage shall be equal to 100 
        percent with respect to amounts expended by a State--
                    ``(A) for medical assistance provided in accordance 
                with this section to relief-eligible survivors of a 
                disaster during the relief coverage period of the 
                disaster and, in the case of individuals described in 
                clause (ii) or (iii) of subsection (b)(5)(C), during 
                the applicable periods described in such clauses; and
                    ``(B) that are directly attributable to 
                administrative activities related to the provision of 
                medical assistance under this section, including costs 
                attributable to obtaining recoveries under subsection 
                (g).
            ``(2) Disregard of limits on payments to territories.--The 
        limitations on payment under subsections (f) and (g) of section 
        1108 shall not apply to Federal payments under this title that 
        are based on the Federal medical assistance percentage 
        described in paragraph (1), and such payments shall be 
        disregarded in applying such subsections.
    ``(g) Penalty for Fraudulent Applications.--
            ``(1) Individual liable for costs.--If a State, as the 
        result of verification activities conducted by the State or 
        otherwise, determines after a fair hearing that an individual 
        has knowingly made a false attestation in an application for 
        medical assistance as a relief-eligible survivor of a disaster 
        under this section, the State shall, subject to paragraph (2), 
        seek recovery from the individual for the full amount of the 
        cost of medical assistance provided to the individual under 
        this section.
            ``(2) Exception.--The Secretary shall exempt a State from 
        the requirement to seek recovery from an individual under 
        paragraph (1) if the Secretary determines that it would not be 
        cost-effective for the State to do so.
            ``(3) Reimbursement to the federal government.--Amounts 
        expended by a State for medical assistance provided to an 
        individual under this section that are subsequently recovered 
        by the State under this subsection shall be treated as an 
        overpayment under this title to the extent that payments were 
        made to the State for such amounts.
    ``(h) Exemption From Error Rate Penalties.--All payments 
attributable to providing medical assistance to relief-eligible 
survivors of disasters in accordance with this section shall be 
disregarded for purposes of section 1903(u).''.

SEC. 3. PROMOTING EFFECTIVE AND INNOVATIVE STATE RESPONSES TO INCREASED 
              DEMAND FOR MEDICAL ASSISTANCE FOLLOWING A DISASTER.

    (a) Guidance on Increasing Access to Providers.--Not later than 
January 1, 2023, the Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall issue (and update as 
the Secretary determines necessary) guidance to State Medicaid 
directors on best practices for--
            (1) expediting the approval of providers under a State 
        Medicaid plan under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.), or waiver of such plan, after a disaster 
        to meet increased demand for medical assistance under the plan 
        or waiver from relief-eligible survivors (as defined in section 
        1948(b)(5) of such Act) of disasters; and
            (2) using out-of-State providers to provide care to relief-
        eligible survivors of a disaster under the plan or waiver.
    (b) Technical Assistance and Support for Innovative State 
Strategies To Respond to Increased Demand for Medical Assistance 
Following a Disasters.--
            (1) In general.--The Secretary shall provide technical 
        assistance and support to States to develop or expand 
        infrastructure, strategies, or innovations (including through 
        State Medicaid demonstration projects) to provide medical 
        assistance under a State Medicaid plan under title XIX of the 
        Social Security Act (42 U.S.C. 1396 et seq.), or a waiver of 
        such a plan, to relief-eligible survivors (as defined in 
        section 1948(b)(5) of such Act) of disasters.
            (2) Report.--Not later than 180 days after the date of 
        enactment of this Act, the Secretary shall issue a report to 
        Congress detailing a plan of action to carry out the 
        requirements of paragraph (1).
    (c) HCBS Emergency Response Corps Grant Program.--
            (1) In general.--The Secretary shall award grants under 
        this subsection to States for the purpose of establishing or 
        operating HCBS emergency response corps that meet the 
        requirements of paragraph (2) to provide medical assistance for 
        home and community-based services under a State Medicaid plan 
        under title XIX of the Social Security Act (42 U.S.C. 1396 et 
        seq.) to relief-eligible survivors (as defined in section 
        1948(b)(5) of such Act) of disasters.
            (2) Home and community-based services emergency response 
        corps.--An HCBS emergency response corps meets the requirements 
        of this paragraph if it satisfies the following requirements:
                    (A) The corps serves a State with a history of 
                hosting individuals who are forced to relocate to the 
                State from another State due to a disaster (as 
                determined by the Secretary).
                    (B) The corps is composed of representatives from 
                each of the following:
                            (i) Voluntary organizations delivering 
                        assistance.
                            (ii) Area agencies on aging (as defined in 
                        section 102 of the Older Americans Act of 1965 
                        (42 U.S.C. 3002)).
                            (iii) The Medicare program under title 
                        XVIII of the Social Security Act (42 U.S.C. 
                        1395 et seq.).
                            (iv) The State agency responsible for 
                        administering the State Medicaid program under 
                        title XIX of the Social Security Act (42 U.S.C. 
                        1396 et seq.).
                            (v) State agencies serving older adults and 
                        people with disabilities.
                            (vi) Nonprofit service providers.
                            (vii) Individuals who are enrolled in the 
                        State Medicaid program under title XIX of the 
                        Social Security Act (42 U.S.C. 1396 et seq.) or 
                        the Children's Health Insurance Program under 
                        title XXI of the Social Security Act (42 U.S.C. 
                        1397aa et seq.).
                            (viii) Centers for independent living, as 
                        described in part C of title VII of the 
                        Rehabilitation Act of 1973 (29 U.S.C. 796f et 
                        seq.).
                            (ix) Other organizations that address the 
                        needs of older adults and people with 
                        disabilities.
                    (C) The corps is led by a representative of a State 
                or nonprofit agency serving older adults or people with 
                disabilities.
                    (D) The corps operates under a plan to meet the 
                acute and long-term services and support needs of 
                relief-eligible survivors (as defined in section 
                1948(b)(5) of the Social Security Act) of disasters, 
                and is provided with the resources necessary to execute 
                such plan.
            (3) Grants.--
                    (A) Limitation.--The Secretary may award a grant 
                under this subsection to up to 5 States.
                    (B) Term of grants.--Grants under this subsection 
                shall be made for a term of 2 years.
            (4) Authorization.--There are authorized to be appropriated 
        to carry out this subsection, $10,000,000 for each of fiscal 
        years 2022 through 2027, to remain available until expended.

SEC. 4. TARGETED MEDICAID RELIEF FOR DIRECT IMPACT AREAS.

    (a) 100 Percent Federal Matching Payments for Medical Assistance 
Provided in a Direct Impact Area.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in subsection (b), by striking ``and (ii)'' and 
                inserting ``(ii), and (jj)''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(jj) 100 Percent FMAP for All Medical Assistance Provided in 
Disaster Direct Impact Areas.--Notwithstanding subsection (b), the 
Federal medical assistance percentage for a State and fiscal year shall 
be equal to 100 percent with respect to amounts expended by the State 
during the fiscal year for medical assistance for an individual who, 
during the fiscal quarter in which the assistance is provided to the 
individual, is a resident of a direct impact area of a disaster during 
the disaster's relief coverage period (as such terms are defined in 
section 1948).''.
            (2) Exclusion of enhanced payments from territorial caps.--
        Notwithstanding any other provision of law, for purposes of 
        section 1108 of the Social Security Act (42 U.S.C. 1308), with 
        respect to any additional amount paid to a territory as a 
        result of the application of section 1905(jj) of the Social 
        Security Act (42 U.S.C. 1396d(jj))--
                    (A) the limitation on payments to territories under 
                subsections (f) and (g) of such section 1108 shall not 
                apply to such additional amounts; and
                    (B) such additional amounts shall be disregarded in 
                applying such subsections.
            (3) Application to chip.--
                    (A) In general.--Section 2105(c) of the Social 
                Security Act (42 U.S.C. 1397ee(a)) is amended by adding 
                at the end the following new paragraph:
            ``(13) 100 percent match for assistance provided in 
        disaster direct impact areas.--Notwithstanding subsection (b), 
        the enhanced FMAP for a State, with respect to payments under 
        subsection (a) for expenditures under the State plan for child 
        health assistance for targeted low-income children or 
        pregnancy-related assistance for individuals who are targeted 
        low-income women that is provided to such a child or individual 
        who, at the time the assistance is provided, is a resident of a 
        direct impact area of a disaster during the disaster's relief 
        coverage period (as such terms are defined in section 1948) 
        shall be equal to 100 percent.''.
                    (B) Adjustment of chip allotments.--Section 2104(m) 
                of the Social Security Act (42 U.S.C. 1397dd(m)) is 
                amended--
                            (i) in paragraph (2)(B), by striking ``and 
                        (12)'' and inserting ``(12), and (13)''; and
                            (ii) by adding at the end the following new 
                        paragraph:
            ``(13) Adjusting allotments to account for increased 
        federal payments for assistance provided in disaster direct 
        impact areas.--If a State (including the District of Columbia 
        and each commonwealth and territory) receives a payment for a 
        fiscal year under subsection (a) of section 2105 for 
        expenditures that are subject to the enhanced FMAP specified 
        under subsection (c)(13) of such section--
                    ``(A) the amount of the allotment determined for 
                the State under this subsection for such fiscal year 
                shall be increased by the product of--
                            ``(i) the amount of such expenditures that 
                        the State is projected to make for such fiscal 
                        year; and
                            ``(ii) a percentage equal to 100 percent 
                        reduced by a number of percentage points equal 
                        to the enhanced FMAP determined for the State 
                        and fiscal year under subsection (b) of section 
                        2105; and
                    ``(B) once actual expenditures for the fiscal year 
                are available, the amount of such allotment, as 
                increased under subparagraph (A), shall be further 
                increased or reduced, as appropriate, on the basis of 
                the difference between--
                            ``(i) the amount of the increase determined 
                        under subparagraph (A); and
                            ``(ii) the product of--
                                    ``(I) the actual amount of State 
                                expenditures that are subject to the 
                                enhanced FMAP specified under section 
                                2105(c)(13); and
                                    ``(II) the percentage determined 
                                for the State under subparagraph 
                                (A)(ii).''.
    (b) Moratorium on Redeterminations.--During the relief coverage 
period (as defined in paragraph (4) of section 1948(b) of the Social 
Security Act, as added by section 2)) of a disaster, a State that 
contains a direct impact area (as defined in paragraph (2) of such 
section) of the disaster shall not be required to conduct eligibility 
redeterminations under the State's plans or waivers of such plans under 
title XIX or XXI of such Act (42 U.S.C. 1396 et seq., 1397aa) with 
respect to individuals who reside in such area.

SEC. 5. AUTHORITY TO WAIVE REQUIREMENTS DURING NATIONAL EMERGENCIES 
              WITH RESPECT TO EVACUEES FROM AN EMERGENCY AREA.

    Section 1135(g)(1) of the Social Security Act (42 U.S.C. 1320b-
5(g)(1)) is amended--
            (1) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii), respectively;
            (2) by striking ``An `emergency area''' and inserting the 
        following:
                    ``(A) In general.--An emergency area''; and
            (3) by adding at the end the following new subparagraph:
            ``(B) Additional areas.--Any geographical area in which the 
        Secretary determines there are a significant number of evacuees 
        from an area described in subparagraph (A) shall also be 
        considered to be an `emergency area' for purposes of this 
        section.''.

SEC. 6. EXCLUSION OF DISASTER RELIEF COVERAGE PERIOD IN COMPUTING 
              MEDICARE PART B LATE ENROLLMENT PERIOD.

    Section 1839(b) of such Act (42 U.S.C. 1395r(b)) is amended, in the 
second sentence, by inserting before the period at the end the 
following: ``or, in the case of an individual who is a survivor of a 
disaster (as defined in paragraph (6) of section 1948(b)), any month 
any part of which is within the relief coverage period (as defined in 
paragraph (4) of such section) of such disaster''.

SEC. 7. EFFECTIVE DATE.

    (a) In General.--Subject to subsection (b), this Act and the 
amendments made by this Act shall take effect on the date of enactment 
of this Act.
    (b) Delay Permitted if State Legislation Required.--In the case of 
a State plan approved under title XIX of the Social Security Act which 
the Secretary of Health and Human Services determines requires State 
legislation (other than legislation appropriating funds) in order for 
the plan to meet the additional requirement imposed by this section, 
the State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of the failure of the 
plan to meet such additional requirement before the 1st day of the 1st 
calendar quarter beginning after the close of the 1st regular session 
of the State legislature that ends after the 1-year period beginning 
with the date of the enactment of this section. For purposes of the 
preceding sentence, in the case of a State that has a 2-year 
legislative session, each year of the session is deemed to be a 
separate regular session of the State legislature.

SEC. 8. IMPACT EVALUATION AND REPORTING.

    (a) In General.--Not later than 24 months after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
enter into a 5 year agreement through a contract, grant, or cooperative 
agreement with an independent nonprofit entity experienced in 
conducting evaluations of program and systems change efforts to--
            (1) conduct a multi-year evaluation on the impact of this 
        Act, with respect to relief-eligible survivors (including 
        people with disabilities and pregnant individuals); and
            (2) prepare the reports described in subsection (c).
    (b) Evaluation.--In carrying out subsection (a)(1), the entity 
awarded a contract, grant, or cooperative agreement under this section 
shall evaluate at a minimum--
            (1) the availability of and access to Medicaid services for 
        relief-eligible survivors under the Medicaid program nationally 
        and in each State, territory and tribal organization, including 
        scope and coverage of services, provision of home and 
        community-based services and extended mental health and care 
        coordination services; and provider capacity;
            (2) the demographics of individuals receiving these 
        benefits, including individuals with disabilities and pregnant 
        individuals; and
            (3) actions taken by States to comply with this Act, 
        including coordination of efforts between States, coordination 
        between State agencies and qualified providers, and activities 
        of HCBS emergency response corps (as described in section 
        3(c)).
    (c) Reports.--The Secretary of Health and Human Services shall 
submit to the Committee on Finance of the Senate, the Special Committee 
on Aging of the Senate, the Committee on Energy and Commerce of the 
House of Representatives, and the Committee on Ways and Means of the 
House of Representatives the following reports on the evaluation 
conducted under subsection (a)(1):
            (1) An interim report on the evaluation, to be submitted 
        not later than 3 years after the evaluation commences.
            (2) A follow-up report on such evaluation, to be submitted 
        not later than 24 months after the date on which the interim 
        report is issued.
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