[Congressional Record Volume 165, Number 51 (Monday, March 25, 2019)]
[House]
[Pages H2773-H2780]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      MEDICAID SERVICES INVESTMENT AND ACCOUNTABILITY ACT OF 2019

  Mr. RUIZ. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 1839) to amend title XIX to extend protection for Medicaid 
recipients of home and community-based services against spousal 
impoverishment, establish a State Medicaid option to provide 
coordinated care to children with complex medical conditions through 
health homes, prevent the misclassification of drugs for purposes of 
the Medicaid drug rebate program, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 1839

       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 ``Medicaid Services Investment 
     and Accountability Act of 2019''.

     SEC. 2. 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), as amended by section 3(a) of the 
     Medicaid Extenders Act of 2019 (Public Law 116-3), is amended 
     by striking ``March 31, 2019'' and inserting ``September 30, 
     2019''.
       (b) Rule of Construction.--
       (1) Protecting state spousal income and asset disregard 
     flexibility under waivers and plan amendments.--Nothing in 
     section 2404 of Public Law 111-148 (42 U.S.C. 1396r-5 note) 
     or section 1924 of the Social Security Act (42 U.S.C. 1396r-
     5) shall be construed as prohibiting a State from 
     disregarding an individual's spousal income and assets under 
     a State waiver or plan amendment described in paragraph (2) 
     for purposes of making determinations of eligibility for home 
     and community-based services or home and community-based 
     attendant services and supports under such waiver or plan 
     amendment.
       (2) State waiver or plan amendment described.--A State 
     waiver or plan amendment described in this paragraph is any 
     of the following:
       (A) A waiver or plan amendment to provide medical 
     assistance for home and community-based services under a 
     waiver or plan amendment under subsection (c), (d), or (i) of 
     section 1915 of the Social Security Act (42 U.S.C. 1396n) or 
     under section 1115 of such Act (42 U.S.C. 1315).
       (B) A plan amendment to provide medical assistance for home 
     and community-based services for individuals by reason of 
     being determined eligible under section 1902(a)(10)(C) of 
     such Act (42 U.S.C. 1396a(a)(10)(C)) or by reason of section 
     1902(f) of such Act (42 U.S.C. 1396a(f)) or otherwise on the 
     basis of a reduction of income based on costs incurred for 
     medical or other remedial care under which the State 
     disregarded the income and assets of the individual's spouse 
     in determining the initial and ongoing financial eligibility 
     of an individual for such services in place of the spousal 
     impoverishment provisions applied under section 1924 of such 
     Act (42 U.S.C. 1396r-5).
       (C) A plan amendment to provide medical assistance for home 
     and community-based attendant services and supports under 
     section 1915(k) of such Act (42 U.S.C. 1396n(k)).

     SEC. 3. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A 
                   HEALTH HOME FOR CHILDREN WITH MEDICALLY COMPLEX 
                   CONDITIONS.

       Title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.) is amended by inserting after section 1945 the 
     following new section:

     ``SEC. 1945A. STATE OPTION TO PROVIDE COORDINATED CARE 
                   THROUGH A HEALTH HOME FOR CHILDREN WITH 
                   MEDICALLY COMPLEX CONDITIONS.

       ``(a) In General.--Notwithstanding section 1902(a)(1) 
     (relating to statewideness) and section 1902(a)(10)(B) 
     (relating to comparability), beginning October 1, 2022, a 
     State, at its option as a State plan amendment, may provide 
     for medical assistance under this title to children with 
     medically complex conditions who choose to enroll in a health 
     home under this section by selecting a designated provider, a 
     team of health care professionals operating with such a 
     provider, or a health team as the child's health home for 
     purposes of providing the child with health home services.
       ``(b) Health Home Qualification Standards.--The Secretary 
     shall establish standards for qualification as a health home 
     for purposes of this section. Such standards shall include 
     requiring designated providers, teams of health care 
     professionals operating with such providers, and health teams 
     to demonstrate to the State the ability to do the following:
       ``(1) Coordinate prompt care for children with medically 
     complex conditions, including access to pediatric emergency 
     services at all times.
       ``(2) Develop an individualized comprehensive pediatric 
     family-centered care plan for children with medically complex 
     conditions that accommodates patient preferences.
       ``(3) Work in a culturally and linguistically appropriate 
     manner with the family of a child with medically complex 
     conditions to develop and incorporate into such child's care 
     plan, in a manner consistent with the needs of the child and 
     the choices of the child's family, ongoing home care, 
     community-based pediatric primary care, pediatric inpatient 
     care, social support services, and local hospital pediatric 
     emergency care.
       ``(4) Coordinate access to--
       ``(A) subspecialized pediatric services and programs for 
     children with medically complex conditions, including the 
     most intensive diagnostic, treatment, and critical care 
     levels as medically necessary; and
       ``(B) palliative services if the State provides such 
     services under the State plan (or a waiver of such plan).
       ``(5) Coordinate care for children with medically complex 
     conditions with out-of-State providers furnishing care to 
     such children to the maximum extent practicable for the 
     families of such children and where medically necessary, in 
     accordance with guidance issued under subsection (e)(1) and 
     section 431.52 of title 42, Code of Federal Regulations.
       ``(6) Collect and report information under subsection 
     (g)(1).
       ``(c) Payments.--
       ``(1) In general.--A State shall provide a designated 
     provider, a team of health care professionals operating with 
     such a provider,

[[Page H2774]]

     or a health team with payments for the provision of health 
     home services to each child with medically complex conditions 
     that selects such provider, team of health care 
     professionals, or health team as the child's health home. 
     Payments made to a designated provider, a team of health care 
     professionals operating with such a provider, or a health 
     team for such services shall be treated as medical assistance 
     for purposes of section 1903(a), except that, during the 
     first 2 fiscal year quarters that the State plan amendment is 
     in effect, the Federal medical assistance percentage 
     applicable to such payments shall be increased by 15 
     percentage points, but in no case may exceed 90 percent.
       ``(2) Methodology.--
       ``(A) In general.--The State shall specify in the State 
     plan amendment the methodology the State will use for 
     determining payment for the provision of health home 
     services. Such methodology for determining payment--
       ``(i) may be tiered to reflect, with respect to each child 
     with medically complex conditions provided such services by a 
     designated provider, a team of health care professionals 
     operating with such a provider, or a health team, the 
     severity or number of each such child's chronic conditions, 
     life-threatening illnesses, disabilities, or rare diseases, 
     or the specific capabilities of the provider, team of health 
     care professionals, or health team; and
       ``(ii) shall be established consistent with section 
     1902(a)(30)(A).
       ``(B) Alternate models of payment.--The methodology for 
     determining payment for provision of health home services 
     under this section shall not be limited to a per-member per-
     month basis and may provide (as proposed by the State and 
     subject to approval by the Secretary) for alternate models of 
     payment.
       ``(3) Planning grants.--
       ``(A) In general.--Beginning October 1, 2022, the Secretary 
     may award planning grants to States for purposes of 
     developing a State plan amendment under this section. A 
     planning grant awarded to a State under this paragraph shall 
     remain available until expended.
       ``(B) State contribution.--A State awarded a planning grant 
     shall contribute an amount equal to the State percentage 
     determined under section 1905(b) (without regard to section 
     5001 of Public Law 111-5) for each fiscal year for which the 
     grant is awarded.
       ``(C) Limitation.--The total amount of payments made to 
     States under this paragraph shall not exceed $5,000,000.
       ``(d) Coordinating Care.--
       ``(1) Hospital notification.--A State with a State plan 
     amendment approved under this section shall require each 
     hospital that is a participating provider under the State 
     plan (or a waiver of such plan) to establish procedures for, 
     in the case of a child with medically complex conditions who 
     is enrolled in a health home pursuant to this section and 
     seeks treatment in the emergency department of such hospital, 
     notifying the health home of such child of such treatment.
       ``(2) Education with respect to availability of health home 
     services.--In order for a State plan amendment to be approved 
     under this section, a State shall include in the State plan 
     amendment a description of the State's process for educating 
     providers participating in the State plan (or a waiver of 
     such plan) on the availability of health home services for 
     children with medically complex conditions, including the 
     process by which such providers can refer such children to a 
     designated provider, team of health care professionals 
     operating such a provider, or health team for the purpose of 
     establishing a health home through which such children may 
     receive such services.
       ``(3) Family education.--In order for a State plan 
     amendment to be approved under this section, a State shall 
     include in the State plan amendment a description of the 
     State's process for educating families with children eligible 
     to receive health home services pursuant to this section of 
     the availability of such services. Such process shall include 
     the participation of family-to-family entities or other 
     public or private organizations or entities who provide 
     outreach and information on the availability of health care 
     items and services to families of individuals eligible to 
     receive medical assistance under the State plan (or a waiver 
     of such plan).
       ``(4) Mental health coordination.--A State with a State 
     plan amendment approved under this section shall consult and 
     coordinate, as appropriate, with the Secretary in addressing 
     issues regarding the prevention and treatment of mental 
     illness and substance use among children with medically 
     complex conditions receiving health home services under this 
     section.
       ``(e) Guidance on Coordinating Care From Out-of-State 
     Providers.--
       ``(1) In general.--Not later than October 1, 2020, the 
     Secretary shall issue (and update as the Secretary determines 
     necessary) guidance to State Medicaid directors on--
       ``(A) best practices for using out-of-State providers to 
     provide care to children with medically complex conditions;
       ``(B) coordinating care for such children provided by such 
     out-of-State providers (including when provided in emergency 
     and non-emergency situations);
       ``(C) reducing barriers for such children receiving care 
     from such providers in a timely fashion; and
       ``(D) processes for screening and enrolling such providers 
     in the respective State plan (or a waiver of such plan), 
     including efforts to streamline such processes or reduce the 
     burden of such processes on such providers.
       ``(2) Stakeholder input.--In carrying out paragraph (1), 
     the Secretary shall issue a request for information to seek 
     input from children with medically complex conditions and 
     their families, States, providers (including children's 
     hospitals, hospitals, pediatricians, and other providers), 
     managed care plans, children's health groups, family and 
     beneficiary advocates, and other stakeholders with respect to 
     coordinating the care for such children provided by out-of-
     State providers.
       ``(f) Monitoring.--A State shall include in the State plan 
     amendment--
       ``(1) a methodology for tracking reductions in inpatient 
     days and reductions in the total cost of care resulting from 
     improved care coordination and management under this section;
       ``(2) a proposal for use of health information technology 
     in providing health home services under this section and 
     improving service delivery and coordination across the care 
     continuum (including the use of wireless patient technology 
     to improve coordination and management of care and patient 
     adherence to recommendations made by their provider); and
       ``(3) a methodology for tracking prompt and timely access 
     to medically necessary care for children with medically 
     complex conditions from out-of-State providers.
       ``(g) Data Collection.--
       ``(1) Provider reporting requirements.--In order to receive 
     payments from a State under subsection (c), a designated 
     provider, a team of health care professionals operating with 
     such a provider, or a health team shall report to the State, 
     at such time and in such form and manner as may be required 
     by the State, the following information:
       ``(A) With respect to each such provider, team of health 
     care professionals, or health team, the name, National 
     Provider Identification number, address, and specific health 
     care services offered to be provided to children with 
     medically complex conditions who have selected such provider, 
     team of health care professionals, or health team as the 
     health home of such children.
       ``(B) Information on all applicable measures for 
     determining the quality of health home services provided by 
     such provider, team of health care professionals, or health 
     team, including, to the extent applicable, child health 
     quality measures and measures for centers of excellence for 
     children with complex needs developed under this title, title 
     XXI, and section 1139A.
       ``(C) Such other information as the Secretary shall specify 
     in guidance.

     When appropriate and feasible, such provider, team of health 
     care professionals, or health team, as the case may be, shall 
     use health information technology in providing the State with 
     such information.
       ``(2) State reporting requirements.--
       ``(A) Comprehensive report.--A State with a State plan 
     amendment approved under this section shall report to the 
     Secretary (and, upon request, to the Medicaid and CHIP 
     Payment and Access Commission), at such time and in such form 
     and manner determined by the Secretary to be reasonable and 
     minimally burdensome, the following information:
       ``(i) Information reported under paragraph (1).
       ``(ii) The number of children with medically complex 
     conditions who have selected a health home pursuant to this 
     section.
       ``(iii) The nature, number, and prevalence of chronic 
     conditions, life-threatening illnesses, disabilities, or rare 
     diseases that such children have.
       ``(iv) The type of delivery systems and payment models used 
     to provide services to such children under this section.
       ``(v) The number and characteristics of designated 
     providers, teams of health care professionals operating with 
     such providers, and health teams selected as health homes 
     pursuant to this section, including the number and 
     characteristics of out-of-State providers, teams of health 
     care professionals operating with such providers, and health 
     teams who have provided health care items and services to 
     such children.
       ``(vi) The extent to which such children receive health 
     care items and services under the State plan.
       ``(vii) Quality measures developed specifically with 
     respect to health care items and services provided to 
     children with medically complex conditions.
       ``(B) Report on best practices.--Not later than 90 days 
     after a State has a State plan amendment approved under this 
     section, such State shall submit to the Secretary, and make 
     publicly available on the appropriate State website, a report 
     on how the State is implementing guidance issued under 
     subsection (e)(1), including through any best practices 
     adopted by the State.
       ``(h) Rule of Construction.--Nothing in this section may be 
     construed--
       ``(1) to require a child with medically complex conditions 
     to enroll in a health home under this section;
       ``(2) to limit the choice of a child with medically complex 
     conditions in selecting a designated provider, team of health 
     care professionals operating with such a provider, or health 
     team that meets the health home qualification standards 
     established under subsection (b) as the child's health home; 
     or

[[Page H2775]]

       ``(3) to reduce or otherwise modify--
       ``(A) the entitlement of children with medically complex 
     conditions to early and periodic screening, diagnostic, and 
     treatment services (as defined in section 1905(r)); or
       ``(B) the informing, providing, arranging, and reporting 
     requirements of a State under section 1902(a)(43).
       ``(i) Definitions.--In this section:
       ``(1) Child with medically complex conditions.--
       ``(A) In general.--Subject to subparagraph (B), the term 
     `child with medically complex conditions' means an individual 
     under 21 years of age who--
       ``(i) is eligible for medical assistance under the State 
     plan (or under a waiver of such plan); and
       ``(ii) has at least--

       ``(I) one or more chronic conditions that cumulatively 
     affect three or more organ systems and severely reduces 
     cognitive or physical functioning (such as the ability to 
     eat, drink, or breathe independently) and that also requires 
     the use of medication, durable medical equipment, therapy, 
     surgery, or other treatments; or
       ``(II) one life-limiting illness or rare pediatric disease 
     (as defined in section 529(a)(3) of the Federal Food, Drug, 
     and Cosmetic Act (21 U.S.C. 360ff(a)(3))).

       ``(B) Rule of construction.--Nothing in this paragraph 
     shall prevent the Secretary from establishing higher levels 
     as to the number or severity of chronic, life threatening 
     illnesses, disabilities, rare diseases or mental health 
     conditions for purposes of determining eligibility for 
     receipt of health home services under this section.
       ``(2) Chronic condition.--The term `chronic condition' 
     means a serious, long-term physical, mental, or developmental 
     disability or disease, including the following:
       ``(A) Cerebral palsy.
       ``(B) Cystic fibrosis.
       ``(C) HIV/AIDS.
       ``(D) Blood diseases, such as anemia or sickle cell 
     disease.
       ``(E) Muscular dystrophy.
       ``(F) Spina bifida.
       ``(G) Epilepsy.
       ``(H) Severe autism spectrum disorder.
       ``(I) Serious emotional disturbance or serious mental 
     health illness.
       ``(3) Health home.--The term `health home' means a 
     designated provider (including a provider that operates in 
     coordination with a team of health care professionals) or a 
     health team selected by a child with medically complex 
     conditions (or the family of such child) to provide health 
     home services.
       ``(4) Health home services.--
       ``(A) In general.--The term `health home services' means 
     comprehensive and timely high-quality services described in 
     subparagraph (B) that are provided by a designated provider, 
     a team of health care professionals operating with such a 
     provider, or a health team.
       ``(B) Services described.--The services described in this 
     subparagraph shall include--
       ``(i) comprehensive care management;
       ``(ii) care coordination, health promotion, and providing 
     access to the full range of pediatric specialty and 
     subspecialty medical services, including services from out-
     of-State providers, as medically necessary;
       ``(iii) comprehensive transitional care, including 
     appropriate follow-up, from inpatient to other settings;
       ``(iv) patient and family support (including authorized 
     representatives);
       ``(v) referrals to community and social support services, 
     if relevant; and
       ``(vi) use of health information technology to link 
     services, as feasible and appropriate.
       ``(5) Designated provider.--The term `designated provider' 
     means a physician (including a pediatrician or a pediatric 
     specialty or subspecialty provider), children's hospital, 
     clinical practice or clinical group practice, prepaid 
     inpatient health plan or prepaid ambulatory health plan (as 
     defined by the Secretary), rural clinic, community health 
     center, community mental health center, home health agency, 
     or any other entity or provider that is determined by the 
     State and approved by the Secretary to be qualified to be a 
     health home for children with medically complex conditions on 
     the basis of documentation evidencing that the entity has the 
     systems, expertise, and infrastructure in place to provide 
     health home services. Such term may include providers who are 
     employed by, or affiliated with, a children's hospital.
       ``(6) Team of health care professionals.--The term `team of 
     health care professionals' means a team of health care 
     professionals (as described in the State plan amendment under 
     this section) that may--
       ``(A) include--
       ``(i) physicians and other professionals, such as 
     pediatricians or pediatric specialty or subspecialty 
     providers, nurse care coordinators, dietitians, 
     nutritionists, social workers, behavioral health 
     professionals, physical therapists, occupational therapists, 
     speech pathologists, nurses, individuals with experience in 
     medical supportive technologies, or any professionals 
     determined to be appropriate by the State and approved by the 
     Secretary;
       ``(ii) an entity or individual who is designated to 
     coordinate such a team; and
       ``(iii) community health workers, translators, and other 
     individuals with culturally-appropriate expertise; and
       ``(B) be freestanding, virtual, or based at a children's 
     hospital, hospital, community health center, community mental 
     health center, rural clinic, clinical practice or clinical 
     group practice, academic health center, or any entity 
     determined to be appropriate by the State and approved by the 
     Secretary.
       ``(7) Health team.--The term `health team' has the meaning 
     given such term for purposes of section 3502 of Public Law 
     111-148.''.

     SEC. 4. EXTENSION OF THE COMMUNITY MENTAL HEALTH SERVICES 
                   DEMONSTRATION PROGRAM.

       Section 223(d)(3) of the Protecting Access to Medicare Act 
     of 2014 (42 U.S.C. 1396a note) is amended by striking ``for 
     2-year demonstration programs under this subsection'' and 
     inserting ``to conduct demonstration programs under this 
     subsection for 2 years or through June 30, 2019, whichever is 
     longer''.

     SEC. 5. ADDITIONAL FUNDING FOR THE MONEY FOLLOWS THE PERSON 
                   REBALANCING DEMONSTRATION.

       Section 6071(h)(1)(F) of the Deficit Reduction Act of 2005 
     (42 U.S.C. 1396a note) is amended by striking 
     ``$112,000,000'' and inserting ``132,000,000''.

     SEC. 6. PREVENTING THE MISCLASSIFICATION OF DRUGS UNDER THE 
                   MEDICAID DRUG REBATE PROGRAM.

       (a) Application of Civil Money Penalty for 
     Misclassification of Covered Outpatient Drugs.--
       (1) In general.--Section 1927(b)(3) of the Social Security 
     Act (42 U.S.C. 1396r-8(b)(3)) is amended--
       (A) in the paragraph heading, by inserting ``and drug 
     product'' after ``price'';
       (B) in subparagraph (A)--
       (i) in clause (ii), by striking ``; and'' at the end and 
     inserting a semicolon;
       (ii) in clause (iii), by striking the period at the end and 
     inserting a semicolon;
       (iii) in clause (iv), by striking the semicolon at the end 
     and inserting ``; and''; and
       (iv) by inserting after clause (iv) the following new 
     clause:
       ``(v) not later than 30 days after the last day of each 
     month of a rebate period under the agreement, such drug 
     product information as the Secretary shall require for each 
     of the manufacturer's covered outpatient drugs.''; and
       (C) in subparagraph (C)--
       (i) in clause (ii), by inserting ``, including information 
     related to drug pricing, drug product information, and data 
     related to drug pricing or drug product information,'' after 
     ``provides false information'';
       (ii) by adding at the end the following new clauses:
       ``(iii) Misclassified drug product or misreported 
     information.--

       ``(I) In general.--Any manufacturer with an agreement under 
     this section that knowingly (as defined in section 1003.110 
     of title 42, Code of Federal Regulations (or any successor 
     regulation)) misclassifies a covered outpatient drug, such as 
     by knowingly submitting incorrect drug product information, 
     is subject to a civil money penalty for each covered 
     outpatient drug that is misclassified in an amount not to 
     exceed 2 times the amount of the difference between--

       ``(aa) the total amount of rebates that the manufacturer 
     paid with respect to the drug to all States for all rebate 
     periods during which the drug was misclassified; and
       ``(bb) the total amount of rebates that the manufacturer 
     would have been required to pay, as determined by the 
     Secretary using drug product information provided by the 
     manufacturer, with respect to the drug to all States for all 
     rebate periods during which the drug was misclassified if the 
     drug had been correctly classified.

       ``(II) Other penalties and recovery of underpaid rebates.--
     The civil money penalties described in subclause (I) are in 
     addition to other penalties as may be prescribed by law and 
     any other recovery of the underlying underpayment for rebates 
     due under this section or the terms of the rebate agreement 
     as determined by the Secretary.

       ``(iv) Increasing oversight and enforcement.--Each year the 
     Secretary shall retain, in addition to any amount retained by 
     the Secretary to recoup investigation and litigation costs 
     related to the enforcement of the civil money penalties under 
     this subparagraph and subsection (c)(4)(B)(ii)(III), an 
     amount equal to 25 percent of the total amount of civil money 
     penalties collected under this subparagraph and subsection 
     (c)(4)(B)(ii)(III) for the year, and such retained amount 
     shall be available to the Secretary, without further 
     appropriation and until expended, for activities related to 
     the oversight and enforcement of this section and agreements 
     under this section, including--

       ``(I) improving drug data reporting systems;
       ``(II) evaluating and ensuring manufacturer compliance with 
     rebate obligations; and
       ``(III) oversight and enforcement related to ensuring that 
     manufacturers accurately and fully report drug information, 
     including data related to drug classification.''; and

       (iii) in subparagraph (D)--

       (I) in clause (iv), by striking ``, and'' and inserting a 
     comma;
       (II) in clause (v), by striking the period and inserting 
     ``, and''; and
       (III) by inserting after clause (v) the following new 
     clause:

       ``(vi) in the case of categories of drug product or 
     classification information that were not considered 
     confidential by the Secretary on the day before the date of 
     the enactment of this clause.''.
       (2) Technical amendments.--

[[Page H2776]]

       (A) Section 1903(i)(10) of the Social Security Act (42 
     U.S.C. 1396b(i)(10)) is amended--
       (i) in subparagraph (C)--

       (I) by adjusting the left margin so as to align with the 
     left margin of subparagraph (B); and
       (II) by striking ``, and'' and inserting a semicolon;

       (ii) in subparagraph (D), by striking ``; or'' and 
     inserting ``; and''; and
       (iii) by adding at the end the following new subparagraph:
       ``(E) with respect to any amount expended for a covered 
     outpatient drug for which a suspension under section 
     1927(c)(4)(B)(ii)(II) is in effect; or''.
       (B) Section 1927(b)(3)(C)(ii) of the Social Security Act 
     (42 U.S.C. 1396r-8(b)(3)(C)(ii)) is amended by striking 
     ``subsections (a) and (b)'' and inserting ``subsections (a), 
     (b), (f)(3), and (f)(4)''.
       (b) Recovery of Unpaid Rebate Amounts Due to 
     Misclassification of Covered Outpatient Drugs.--
       (1) In general.--Section 1927(c) of the Social Security Act 
     (42 U.S.C. 1396r-8(c)) is amended by adding at the end the 
     following new paragraph:
       ``(4) Recovery of unpaid rebate amounts due to 
     misclassification of covered outpatient drugs.--
       ``(A) In general.--If the Secretary determines that a 
     manufacturer with an agreement under this section paid a 
     lower per-unit rebate amount to a State for a rebate period 
     as a result of the misclassification by the manufacturer of a 
     covered outpatient drug (without regard to whether the 
     manufacturer knowingly made the misclassification or should 
     have known that the misclassification would be made) than the 
     per-unit rebate amount that the manufacturer would have paid 
     to the State if the drug had been correctly classified, the 
     manufacturer shall pay to the State an amount equal to the 
     product of--
       ``(i) the difference between--

       ``(I) the per-unit rebate amount paid to the State for the 
     period; and
       ``(II) the per-unit rebate amount that the manufacturer 
     would have paid to the State for the period, as determined by 
     the Secretary, if the drug had been correctly classified; and

       ``(ii) the total units of the drug paid for under the State 
     plan in the period.
       ``(B) Authority to correct misclassifications.--
       ``(i) In general.--If the Secretary determines that a 
     manufacturer with an agreement under this section has 
     misclassified a covered outpatient drug (without regard to 
     whether the manufacturer knowingly made the misclassification 
     or should have known that the misclassification would be 
     made), the Secretary shall notify the manufacturer of the 
     misclassification and require the manufacturer to correct the 
     misclassification in a timely manner.
       ``(ii) Enforcement.--If, after receiving notice of a 
     misclassification from the Secretary under clause (i), a 
     manufacturer fails to correct the misclassification by such 
     time as the Secretary shall require, until the manufacturer 
     makes such correction, the Secretary may do any or all of the 
     following:

       ``(I) Correct the misclassification, using drug product 
     information provided by the manufacturer, on behalf of the 
     manufacturer.
       ``(II) Suspend the misclassified drug and the drug's status 
     as a covered outpatient drug under the manufacturer's 
     national rebate agreement, and exclude the misclassified drug 
     from Federal financial participation in accordance with 
     section 1903(i)(10)(E).
       ``(III) Impose a civil money penalty (which shall be in 
     addition to any other recovery or penalty which may be 
     available under this section or any other provision of law) 
     for each rebate period during which the drug is misclassified 
     not to exceed an amount equal to the product of--

       ``(aa) the total number of units of each dosage form and 
     strength of such misclassified drug paid for under any State 
     plan during such a rebate period; and
       ``(bb) 23.1 percent of the average manufacturer price for 
     the dosage form and strength of such misclassified drug.
       ``(C) Reporting and transparency.--
       ``(i) In general.--The Secretary shall submit a report to 
     Congress on at least an annual basis that includes 
     information on the covered outpatient drugs that have been 
     identified as misclassified, any steps taken to reclassify 
     such drugs, the actions the Secretary has taken to ensure the 
     payment of any rebate amounts which were unpaid as a result 
     of such misclassification, and a disclosure of expenditures 
     from the fund created in subsection (b)(3)(C)(iv), including 
     an accounting of how such funds have been allocated and spent 
     in accordance with such subsection.
       ``(ii) Public access.--The Secretary shall make the 
     information contained in the report required under clause (i) 
     available to the public on a timely basis.
       ``(D) Other penalties and actions.--Actions taken and 
     penalties imposed under this clause shall be in addition to 
     other remedies available to the Secretary including 
     terminating the manufacturer's rebate agreement for 
     noncompliance with the terms of such agreement and shall not 
     exempt a manufacturer from, or preclude the Secretary from 
     pursuing, any civil money penalty under this title or title 
     XI, or any other penalty or action as may be prescribed by 
     law.''.
       (2) Offset of recovered amounts against medical 
     assistance.--Section 1927(b)(1)(B) of the Social Security Act 
     (42 U.S.C. 1396r-8(b)(1)(B)) is amended by inserting ``, 
     including amounts received by a State under subsection 
     (c)(4),'' after ``in any quarter''.
       (c) Clarifying Definitions.--Section 1927(k) of the Social 
     Security Act (42 U.S.C. 1396r-8(k)) is amended--
       (1) in paragraph (2)(A), by striking ``paragraph (5)'' and 
     inserting ``paragraph (4)''; and
       (2) in paragraph (7)(A)--
       (A) by striking ``an original new drug application'' and 
     inserting ``a new drug application'' each place it appears;
       (B) in clause (i), by striking ``(not including any drug 
     described in paragraph (5))'' and inserting ``, including a 
     drug product approved for marketing as a non-prescription 
     drug that is regarded as a covered outpatient drug under 
     paragraph (4),'';
       (C) in clause (ii)--
       (i) by striking ``was originally marketed'' and inserting 
     ``is marketed''; and
       (ii) by inserting ``, unless the Secretary determines that 
     a narrow exception applies (as described in section 447.502 
     of title 42, Code of Federal Regulations (or any successor 
     regulation))'' before the period; and
       (D) in clause (iv)--
       (i) by inserting ``, including a drug product approved for 
     marketing as a non-prescription drug that is regarded as a 
     covered outpatient drug under paragraph (4),'' after 
     ``covered outpatient drug'';
       (ii) by inserting ``unless the Secretary determines that a 
     narrow exception applies (as described in section 447.502 of 
     title 42, Code of Federal Regulations (or any successor 
     regulation))'' after ``under the new drug application''; and
       (iii) by adding at the end the following new sentence: 
     ``Such term also includes a covered outpatient drug that is a 
     biological product licensed, produced, or distributed under a 
     biologics license application approved by the Food and Drug 
     Administration.''.
       (d) Exclusion of Manufacturers for Knowing 
     Misclassification of Covered Outpatient Drugs.--Section 
     1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b)) is 
     amended by adding at the end the following new paragraph:
       ``(17) Knowingly misclassifying covered outpatient drugs.--
     Any manufacturer or officer, director, agent, or managing 
     employee of such manufacturer that knowingly misclassifies a 
     covered outpatient drug under an agreement under section 
     1927, knowingly fails to correct such misclassification, or 
     knowingly provides false information related to drug pricing, 
     drug product information, or data related to drug pricing or 
     drug product information.''.
       (e) Effective Date.--The amendments made by this section 
     shall take effect on the date of the enactment of this Act, 
     and shall apply to covered outpatient drugs supplied by 
     manufacturers under agreements under section 1927 of the 
     Social Security Act (42 U.S.C. 1396r-8) on or after such 
     date.

     SEC. 7. EXTENSION OF THIRD-PARTY LIABILITY PERIOD FOR CHILD 
                   SUPPORT SERVICES.

       (a) In General.--Section 202(a)(2) of the Bipartisan Budget 
     Act of 2013 (Public Law 113-67) is amended by striking ``90 
     days'' and inserting ``100 days''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect on the date of the enactment of this Act.

     SEC. 8. DENIAL OF FFP FOR CERTAIN EXPENDITURES RELATING TO 
                   VACUUM ERECTION SYSTEMS AND PENILE PROSTHETIC 
                   IMPLANTS.

       (a) In General.--Section 1903(i) of the Social Security Act 
     (42 U.S.C. 1396b(i)) is amended by inserting after paragraph 
     (11) the following:
       ``(12) with respect to any amounts expended for--
       ``(A) a vacuum erection system that is not medically 
     necessary; or
       ``(B) the insertion, repair, or removal and replacement of 
     a penile prosthetic implant (unless such insertion, repair, 
     or removal and replacement is medically necessary); or''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to items and services furnished on 
     or after January 1, 2020.

     SEC. 9. 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.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Ruiz) and the gentleman from Texas (Mr. Burgess) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. RUIZ. Mr. Speaker, I ask unanimous consent that all Members have 
5 legislative days to revise and extend their remarks and include 
extraneous material on H.R. 1839.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?

[[Page H2777]]

  There was no objection.
  Mr. RUIZ. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am humbled to rise in support of H.R. 1839, the 
Medicaid Services Investment and Accountability Act, a bill that will 
strengthen our healthcare system by putting patients first.
  I am an emergency physician, and as a doctor I have treated patients 
who, because they couldn't afford the care they needed, slipped through 
the cracks, worsening their quality of life, harming themselves and 
their families, and sometimes ending up in the emergency department for 
lifesaving care.
  This bill makes five essential reforms to Medicaid that put patients 
first, helping children and individuals with mental health issues 
access the care that they need.
  The bill's first reform reflects the hard work and tireless efforts 
of my friend, Representative Dingell, who has led the fight to extend 
Medicaid spousal impoverishment protections. Thanks to Representative 
Dingell's advocacy, patients will be able to afford treatment and 
services without bankrupting their spouses.
  Without this important protection, families would face a terrible 
choice between either unnecessary institutionalization or impoverishing 
themselves to ensure that their loved one receives the care that they 
need.
  I would also like to thank Congressman Upton for championing this 
important policy.
  Second, my bill would provide additional funds to the successful 
Money Follows the Person demonstration. This funding will help more 
individuals transition from institutions to the communities they call 
home. I wanted to thank Representatives Dingell and Guthrie for their 
advocacy on behalf of the patients and families who continue to benefit 
from this successful program.
  Third, this bill includes the Advancing Care for Exceptional Kids 
Act, bipartisan legislation that gives States the flexibility to 
coordinate the most effective care for children with medically complex 
needs. The ACE Kids Act would not be possible without the sustained 
advocacy and hard work of Congresswoman Castor.
  Representative Castor is an incredible advocate for some of our most 
vulnerable children and their families and has spent years championing 
this bill. I also want to thank my friend, Representative Bilirakis, 
for continuing to fight to ensure that our sickest kids have access to 
health homes.
  Fourth, this bill contains important program integrity improvements 
to Medicaid, fixes that will save money and make Medicaid run more 
efficiently and effectively without sacrificing quality of care for 
patients.
  That includes legislation championed by Representatives Schrader and 
Welch to crack down on drug companies cheating the Medicaid program by 
not paying proper rebates on their drugs. The bill also gives the 
Department of Health and Human Services the tools it needs to hold ill-
intentioned pharmaceutical companies accountable, while ensuring that 
patients who depend on these drugs continue to have access to them.
  Fifth, and finally, this bill extends funding for the Excellence in 
Mental Health Act, so that people who are struggling with mental health 
and substance use disorders can continue receiving the treatment they 
need. The extension will help Congress find a longer-term solution so 
that this program can continue providing care to the people who need 
it.
  I would like to thank Representative Matsui for her continued hard 
work to support this demonstration. In brief, this bipartisan bill 
strengthens Medicaid by putting patients first. It was the approach I 
took as a doctor in the emergency department, and one I am continuing 
to take in Congress.
  I know this bill will make our healthcare system stronger and more 
equitable, and I am proud to lead this critical effort.
  I urge my colleagues to support the passage of H.R. 1839, the 
Medicaid Services Investment and Accountability Act of 2019, and I 
reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to speak today in support of H.R. 1839, the 
Medicaid Services Investment and Accountability Act of 2019.
  This is a bipartisan Medicaid extenders package that moves forward 
House priorities with responsible offsets. In fact, this package 
actually saves the Federal Government $1 million.
  H.R. 1839 includes a new program to improve access to healthcare from 
medically complex children and reauthorizes important and effective 
programs that benefit Americans each and every day.

                              {time}  1730

  Money Follows the Person is an important program for the State of 
Texas. This Medicaid demonstration, which was established in 2005, has 
enabled eligible individuals in States across our Nation to receive 
long-term care services in their homes or other community settings, 
rather than an institution such as a nursing home.
  While I am disappointed that H.R. 1839 includes only $20 million to 
extend this critical program through September instead of through the 
end of calendar year 2019, I am pleased that the funding for Money 
Follows the Person was ultimately included in this package.
  This bill also includes an extension through September of the 
protection for Medicaid recipients of home and community-based services 
against spousal impoverishment program. This program specifically 
protects married individuals requiring Medicaid-covered and long-term 
services and supports to ensure that they do not have to deplete their 
financial resources or bankrupt themselves in order to become or remain 
Medicaid-eligible to receive such services. Our seniors are among our 
most vulnerable citizens, and it is programs such as this that will 
help protect them from financial ruin.
  According to the National Institute of Mental Health, nearly one in 
five United States adults lives with a mental illness. Programs 
established to help individuals who are struggling with mental health 
issues, including the Excellence in Mental Health program, enable 
States to implement community behavioral health centers to address the 
needs of their populations. H.R. 1839 extends the Excellence in Mental 
Health program funding for Oregon and Oklahoma so that they will be on 
the same financial cycle as other States that are participating in the 
program.
  The ACE Kids Act, which will improve care for children with complex 
medical needs, is also included in this package. The goal of this 
legislation is to improve comprehensive care for medically complex 
children through a State option to create a Medicaid health home 
specific to children. Health homes have proven effective in improving 
care coordination in the adult Medicaid population and hold promise for 
complex pediatric patients.
  However, I want to clarify that this legislation is not intended to 
limit families or their physicians from selecting the provider of 
choice for medical services. There is nothing in this legislation that 
restricts the child's family or their physician from deciding who is 
best qualified as a Medicare provider. The Centers for Medicare and 
Medicaid Services has provided assurances that current freedom of 
choice rules will apply to new care coordination activity.
  As a physician, I know that many children with chronic illnesses have 
a strong relationship with their physician and with other providers. I 
want to make certain that this new law will help families coordinate 
their care without affecting the relationship that families have with 
their current doctor or other medical care provider or other providers 
in their communities from whom they may wish to receive care.
  This package contains must-pass provisions that will improve access 
for Medicaid beneficiaries, which is a laudable and important goal. Not 
only are these provisions imperative, but they are responsibly offset. 
In fact, this package saves money.
  I would particularly like to thank the Energy and Commerce Committee 
staff, in particular J.P. Paluskiewicz and Caleb Graff, who have spent 
a significant amount of their lives negotiating this package to get it 
to the floor.
  I support this legislation, and I urge other Members to continue to 
support this and get the other body to take it up and pass it as well.

[[Page H2778]]

  Mr. Speaker, I reserve the balance of my time.
  Mr. RUIZ. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
California (Ms. Matsui).
  Ms. MATSUI. Mr. Speaker, I rise in support of the Medicaid Services 
Investment and Accountability Act of 2019 and the important provisions 
within this legislation to address mental health and addiction.
  Every one of us knows someone who has struggled, is struggling, or 
will struggle with mental health issues. Whether it is a friend, a 
neighbor, or a family member, mental illness impacts all of us in some 
way.
  Several years ago, we took a huge step forward to expand access to 
mental health services in communities across the Nation. The Excellence 
in Mental Health Act of 2014 was the culmination of years of hard work. 
At the same time, it was the largest Federal investment toward 
improving community-based mental healthcare.
  That legislation allowed States to establish certified community 
behavioral health centers to ensure everyone who needs mental health 
services can receive them. These clinics have expanded mental health 
and substance use treatments dramatically, increasing access to 24-hour 
care, and they have been extremely successful in showing us how we can 
achieve real results in our communities.
  Patients can receive medication-assisted treatment at almost every 
clinic. For many patients and providers, this is the first time that 
such services have been available in their communities, which are very 
often in medically underserved areas. Over half of these clinics now 
offer same-day access to care, which is so critical to those suffering 
from an acute mental health crisis.
  I recently heard from a clinic in Oregon that will lose funding at 
the end of this week if Congress doesn't act now. This clinic has 
doubled the amount of time their doctors are able to spend with 
patients, has been able to hire more staff, and goes to meet patients 
in the community to better serve the unique needs of this population. 
We cannot afford to let this progress expire.
  For far too long, those with mental illness have been left in the 
shadows, and mental health prevention and treatment have been left out 
of our health systems.
  The mental health crisis in this country is very personal to me, and 
I have been fighting for patients and their loved ones for many years. 
I believe there is a lot we can do better to stop or slow down the hurt 
and pain patients and families feel when mental health is left 
unaddressed.

  The bill before us today will extend this critical program in two 
States, Oregon and Oklahoma, until June and is a first step toward 
funding and expanding the program later this year.
  There is a lot more we must do, and I look forward to continuing to 
work with my colleague, Representative Markwayne Mullin, to preserve 
this vital program.
  Mr. BURGESS. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Oregon (Mr. Walden), who is the Republican leader of the 
Energy and Commerce Committee.
  Mr. WALDEN. Mr. Speaker, to my colleagues on both sides of the aisle, 
this is really important legislation we are working on today. H.R. 
1839, the Medicaid Services Investment and Accountability Act of 2019, 
includes short-term extensions of several key Medicaid programs that 
have previously passed the House on a bipartisan basis.
  I know our staffs on both sides of the aisle put a lot of time and 
effort into this, and I thank them all. I especially want to draw 
attention to Caleb Graff, who brought his own audience with him today 
in the gallery, his parents and brother. He has worked very hard on 
this, and we appreciate it.
  I thank my chair and colleague, Frank Pallone of the Energy and 
Commerce Committee, for the partnership on this extenders package. 
Personally, I know a lot of us would have liked to have had these 
extended programs go out further to give beneficiaries and providers 
more certainty and more stability, and we will continue to put forth 
offers in good faith to work across the aisle to fund these critical 
parts of America's safety net.
  However, we are here today up against a deadline, and I am pleased we 
were able to get at least through June and September, respectively, 
with these programs.
  I am particularly pleased to see this package includes a short-term 
extension of the Excellence in Mental Health demonstration for my home 
State of Oregon. Both Oregon and Oklahoma were set to run out of 
funding at the end of this month, so this money will at least line them 
up with the other participating States whose funding expires at the end 
of June.
  These eight State demonstration projects have shown promise as a way 
for community providers to expand access to treatment for mental and 
behavioral health, including addiction. As we continue our bipartisan 
work on the opioid crisis, which took more than 70,000 American lives 
in 2017 alone, Mr. Speaker, our behavioral health centers have the 
potential to provide real help. I have been encouraged to hear from 
providers in rural parts of my district, like Wallowa and Klamath 
Falls, about their success implementing this very program. I look 
forward to working on a longer term extension in the coming months.
  The other Medicaid policies included in this bill are also very 
important.
  The Money Follows the Person program is a demonstration program that 
helps transition individuals with chronic conditions and disabilities 
from institutions back into their local communities. That is where they 
can get the best care.
  The so-called spousal impoverishment program protects seniors against 
the high costs of home and community-based services.
  Finally, we are, once again, passing the ACE Kids Act here in the 
House, which was championed by our former colleague and chairman of the 
committee, Representative Joe Barton of Texas. It would improve the 
delivery of care for children with really complex medical conditions.
  Mr. Speaker, I urge all our colleagues on both sides of the aisle to 
support this bipartisan package of healthcare bills.
  The SPEAKER pro tempore. Members are reminded to avoid referencing 
occupants of the gallery.
  Mr. RUIZ. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Florida (Ms. Castor).
  Ms. CASTOR of Florida. Mr. Speaker, I thank my colleague and friend, 
Dr. Ruiz, for yielding the time.
  Mr. Speaker, on behalf of families of children with complex medical 
needs--and there are many families like this all across America--I rise 
to urge approval of H.R. 1839, which includes a bill I have been 
working on for a number of years with my colleagues, including former 
Representative Joe Barton. It is called the ACE Kids Act.
  We drafted the Advancing Care for Exceptional Kids Act a few years 
ago with a simple but important goal of putting children and their 
families first. The bill authorizes the creation of cost-saving and 
time-saving health homes where specialized care is coordinated in a 
high-quality setting.
  Mr. Speaker, the children with complex medical conditions and their 
families are heroic, like Caroline West in my hometown of Tampa. She 
has a rare genetic condition, cerebral palsy, and a seizure disorder. 
She can't walk, and it is very difficult for her to speak, but she 
attends school part time and enjoys the life of a typical teenager, in 
many respects.
  Lucy Ferlita is the only living person in the United States with 
early onset myopathy with areflexia, respiratory distress, and 
dysphagia. Very little is known about this disease, but we know that it 
is very difficult for her to eat. She has to have a feeding tube, a 
ventilator to breathe, and nursing care 24 hours a day.
  Jaden Velasquez has a congenital heart defect.
  Lakota Lockhart has a central nervous system disorder that causes him 
to not be able to breathe while he sleeps.
  I met all of these kids back home in Tampa at St. Joseph's Children's 
Hospital. St. Joe's has a world-renown Chronic-Complex Clinic that was 
started 16 years ago by a compassionate pediatrician, Dr. Daniel 
Plasencia. This ACE Kids Act is modeled upon their work and the other 
good work being done at children's hospitals across this country.
  The bill provides an incentive for States to establish health homes 
to

[[Page H2779]]

better coordinate care for kids with medical complexities. It also 
directs HHS to provide guidance to States on best practices.
  Mr. Speaker, I urge my colleagues to adopt this bill with the ACE 
Kids Act included.
  Mr. Speaker, I include in the Record a letter from a whole host of 
organizations thanking us for our leadership and for introducing this 
bipartisan legislation to improve care for children with complex 
medical conditions.
                                                   March 25, 2019.
     Hon. Chuck Grassley,
     Washington, DC.
     Hon. Michael Bennet,
     Washington, DC.
     Hon. Kathy Castor,
     Washington, DC.
     Hon. Gus Bilirakis,
     Washington, DC.
     Hon. Anna Eshoo,
     Washington, DC.
     Hon. Jaime Herrera Beutler,
     Washington, DC.
       Dear Sens. Grassley and Bennet, and Reps. Castor, 
     Bilirakis, Eshoo, and Herrera Beutler: As national 
     organizations committed to children's health, we write in 
     strong support of the ``Advancing Care for Exceptional Kids 
     Act of 2019'' (ACE Kids Act, S. 317/H.R. 1226), which has 
     been incorporated into the Medicaid Services Investment and 
     Accountability Act of 2019 (H.R. 1839). We thank you for your 
     leadership in introducing this bipartisan legislation to 
     improve care for children with complex medical conditions in 
     the Medicaid program.
       Children with complex medical conditions have chronic life-
     limiting illnesses and disabilities, and often see six or 
     more specialists and a dozen or more physicians. Under the 
     current Medicaid system, parents of children with multiple, 
     life-threatening disabilities struggle to coordinate the 
     complex care of their kids, which often requires travelling 
     to out-of-state providers. The ACE Kids Act works to create a 
     patient-centered, pediatric-focused delivery system for this 
     unique population of children. It is an important step in 
     fixing the current fragmented system for children with 
     complex medical conditions, ensuring ready access to care and 
     reducing the burden on their families.
       Under the ACE Kids Act, specially-designed health homes 
     created for children with complex medical conditions will 
     employ national quality standards and coordinate care--both 
     essential to improving overall quality of care. These health 
     homes will include the full range of acute, post-acute and 
     primary care providers, and will focus on outpatient care to 
     ensure children get the care that they need in the most 
     appropriate setting closest to home while reducing 
     unnecessary hospitalizations and emergency room visits. The 
     ACE Kids Act--which is voluntary for states, families and 
     providers--will also help families access the array of 
     outpatient and community services and supports needed by 
     these children.
       Providing children with complex medical conditions enrolled 
     in Medicaid the best possible care is a national challenge, 
     and the ACE Kids Act will bring us closer to ensuring these 
     vulnerable children receive the care they need. We are proud 
     to support the ACE Kids Act, and we look forward to working 
     with you to advance this critical legislation this year.
           Sincerely,
       American Academy of Pediatrics; American Association for 
     Psychoanalysis in Clinical Social Work; American Association 
     of Child and Adolescent Psychiatry; The American Board of 
     Pediatrics; American College of Cardiology; American College 
     of Surgeons; American Heart Association; American Physical 
     Therapy Association; American Psychological Association; 
     American Society of Echocardiography; American Thoracic 
     Society; America's Essential Hospitals; Association of 
     American Medical Colleges; Association of Medical School 
     Pediatric Department Chairs; Autism Society of America; 
     Autism Speaks.
       Children's Cause for Cancer Advocacy; Children's Hospital 
     Association; ChildServe; Epilepsy Foundation; Family Voices; 
     March of Dimes; Maxim Healthcare Services; Mended Little 
     Hearts; Moms Rising; National Association for Children's 
     Behavioral Health; National Association of Pediatric Nurse 
     Practitioners; National Board for Certified Counselors; 
     National Down Syndrome Society; Pediatric Congenital Heart 
     Association; Tricare for Kids Coalition; Vizient.
  Mr. BURGESS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Michigan (Mr. Upton), who is the former chairman of the Energy and 
Commerce Committee and the author of the Cures for the 21st Century 
bill.
  Mr. UPTON. Mr. Speaker, I rise in strong support of this bipartisan 
legislation.
  I just want to remark briefly to my colleague from Florida (Ms. 
Castor) that the ACE Kids bill was a very important bill that we worked 
on actually for three Congresses. Joe Barton and the gentlewoman did a 
marvelous job. We didn't quite get it done. We passed it in this House 
with more than 400 votes in the last Congress. At the end, the Senate 
just didn't take it up.
  It is very important that it is included as part of this bipartisan 
package, which we hope is early enough that we can get the Senate to 
act and pass it, because it really does impact families that are in 
much need.
  I also am happy that we are moving this comprehensive bill today 
because it does contain a variety of important extensions. All of them 
had hearings and a lot of bipartisan support from the very first. This 
includes protections against spousal impoverishment for those seniors 
who have a spouse who is receiving home-based long-term care under 
Medicaid.
  Back in 2010, we temporarily mandated these protections for home 
care, but that mandate was set to expire at the end of this very week, 
so it has to be extended.
  Last year, my good friend and colleague, Mrs. Dingell, and I 
introduced a bill to make the spousal impoverishment protections 
permanent, and we worked hard to get that done and passed here in this 
House. But at the end, even though we worked tirelessly on this, we got 
only a temporary extension. That is why it expires the end of this 
week.
  This bill doesn't permanently extend it like we had hoped last year, 
but it does give a reprieve by extending the protection until the end 
of this year, so, in essence, a 9-month extension. It is my hope that 
we can use the time to actually pass a permanent extension.
  I particularly commend the work of my colleague, Mrs. Dingell from 
the great State of Michigan, for her passion on this, to make sure that 
we can get it done. I applaud the Speaker for getting it scheduled on 
the House floor early so that we can get it done, hopefully, this week, 
and the Senate can concur. Then let's use the time to really make it 
permanent, to help these families that otherwise will have funds taken 
out, as this really does rely on Medicaid, to a large degree.

                              {time}  1745

  Mr. RUIZ. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Michigan (Mrs. Dingell).
  Mrs. DINGELL. Mr. Speaker, I thank my colleague from California for 
his leadership on this issue and for yielding me time.
  Mr. Speaker, I rise to speak in support of H.R. 1839, the Medicaid 
Services Investment and Accountability Act.
  This bill includes two provisions that are very important to seniors 
and the disabled. It makes improvements, but, as you have heard my 
other colleagues talk about, not enough and not for long enough.
  First of all, it has a provision that I worked on with my colleague, 
Mr. Upton, that extends the spousal impoverishment protections for 
seniors in Medicaid through the end of the fiscal year. These critical 
protections ensure that individuals are not forced to spend down almost 
all of their resources and potentially go bankrupt to get the care that 
they need. No American should be forced into poverty just to receive 
adequate healthcare.
  In addition, this bill contains a provision that I worked on with my 
colleague, Mr. Guthrie, to extend the highly successful Money Follows 
the Person program, again, just through the end of the fiscal year. 
This program provides grants to States to help individuals voluntarily 
transition from an institutional setting to a community care setting, 
their own home. All Americans, regardless of income, deserve to receive 
long-term care in a setting that they prefer.
  While I am pleased that these programs will be extended through the 
end of September and not allowed to lapse--and that is critical--this 
is only a partial victory. Both the Money Follows the Person program 
and spousal impoverishment protections need to be extended for the long 
term, not a few months at a time. We keep doing that. It was 3 months 
ago that we just extended it for 3 months.
  Seniors and individuals with disabilities need to have security. They 
need to know and have peace of mind that these important provisions are 
going to be there for the long term. And States need stability and 
certainty in order to fully implement these efforts.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Kentucky (Mr. Guthrie), a valuable member of the Energy and Commerce 
Committee and the Republican leader of the Oversight and Investigations 
Subcommittee.

[[Page H2780]]

  

  Mr. GUTHRIE. Mr. Speaker, I rise today in support of H.R. 1839, which 
extends the important Medicaid Money Follows the Person program until 
September.
  The Medicaid Money Follows the Person program allows certain Medicaid 
beneficiaries, such as the elderly or individuals with disabilities, to 
transition from a healthcare facility to receiving care in their own 
homes. It does not force patients to leave a facility if they don't 
want to.
  Since the Money Follows the Person program was created over a decade 
ago, it has successfully helped over 88,000 individuals receive care in 
their own homes.
  I have worked with Congresswoman Debbie Dingell on the bipartisan 
EMPOWER Care Act, which extends the Medicaid Money Follows the Person 
program for 5 years.
  I urge my colleagues to support H.R. 1839 to extend the program until 
September, and I will continue to work with Congresswoman Dingell to 
get the EMPOWER Act across the finish line.
  Mr. RUIZ. Mr. Speaker, I am ready to close.
  Mr. Speaker, I urge my colleagues to support this bipartisan bill, 
H.R. 1839. I really thank all the Members who put their heart and soul 
into their pieces of legislation. I thank the staff of the Energy and 
Commerce Committee, both Democratic and Republican, who have come 
together to work to plug a hole, to fill in the cracks, and to make 
sure that services continue, that value is given, and that healthcare 
puts our patients first, our kids first, so that we can give them the 
appropriate care that they deserve, no matter where they are from or 
whether or not they can afford it.
  This is why I am so humbled to carry the water on this bill. On 
behalf of myself, my staff, and my office, I thank everybody involved 
in this bill.
  Mr. Speaker, I urge support for this bipartisan bill, H.R. 1839, and 
I yield back the balance of my time.
  Mr. BURGESS. Mr. Speaker, this is an important bill, and I urge all 
Members to support it.
  Once again, I want to single out and thank J.P. Paluskiewicz and 
Caleb Graff for really moving heaven and earth to get this to the floor 
so that these valuable programs do not lapse.
  Mr. Speaker, I yield back the balance of my time.
  Ms. JOHNSON of Texas. Mr. Speaker, I rise today to voice my support 
for H.R. 1839, the Medicaid Services Investment and Accountability Act 
of 2019.
  This bill would extend programs that help seniors and people with 
disabilities live in the community, rather than institutions. It would 
extend the authorization of the Excellence in Mental Health 
demonstration so that none of the participating states run out of 
critical funds. It would authorize additional program integrity 
measures in the Medicaid Drug Rebate Program and in other areas of the 
Medicaid program. Finally, it would provide states with the option to 
provide coordinated care for children with medically complex 
conditions.
  As representatives of Americans from all corners of our country, we 
have a responsibility to protect and enhance Medicaid, a vital safety 
net program that finances the delivery of care to 69 million people in 
this country. Without this program, the quality and access of 
healthcare for our most vulnerable populations will be at risk. We must 
ensure that future generations are able to receive the necessary health 
benefits to live full and prosperous lives.
  On behalf of the over four and a half million Medicaid beneficiaries 
in my home state of Texas, I am proud to support the Medicaid Services 
Investment and Accountability Act of 2019.
  I urge my colleagues to support this bill.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Ruiz) that the House suspend the rules 
and pass the bill, H.R. 1839, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BURGESS. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.
  The point of no quorum is considered withdrawn.

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