[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2675 Introduced in Senate (IS)]
<DOC>
114th CONGRESS
2d Session
S. 2675
To provide for the adjustment of the debts of the Commonwealth of
Puerto Rico, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 14, 2016
Mr. Menendez (for himself, Mr. Schumer, Mr. Brown, Mr. Blumenthal, Ms.
Warren, and Mr. Booker) introduced the following bill; which was read
twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide for the adjustment of the debts of the Commonwealth of
Puerto Rico, 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 ``Puerto Rico Recovery Act of 2016''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--TAX PROVISIONS
Sec. 101. Puerto Rico residents eligible for earned income tax credit.
Sec. 102. Equitable treatment for residents of Puerto Rico with respect
to the refundable portion of the child tax
credit.
TITLE II--HEALTH CARE PARITY
Subtitle A--Medicaid
Sec. 201. Elimination of general Medicaid funding limitations (``cap'')
for territories.
Sec. 202. Elimination of specific Federal medical assistance percentage
(FMAP) limitation for territories.
Sec. 203. Application of Medicaid waiver authority to all of the
territories.
Sec. 204. Application of 100 percent Federal poverty line (FPL)
limitation to territories.
Sec. 205. Permitting Medicaid DSH allotments for territories.
Subtitle B--Medicare
Sec. 211. Calculation of Medicare DSH payments for IPPS hospitals in
Puerto Rico.
Sec. 212. Application of part B deemed enrollment process to residents
of Puerto Rico; special enrollment period
and limit on late enrollment penalties.
Sec. 213. Puerto Rico practice expense GPCI improvement.
Sec. 214. Adjustment in benchmark for low base payment counties in
Puerto Rico.
Sec. 215. Eliminating exclusion of part D eligible individuals residing
in territories from eligibility for premium
and cost-sharing subsidies.
Sec. 216. Report on treatment of territories under Medicare part D.
Subtitle C--Miscellaneous
Sec. 221. Report on exclusion of territories from Exchanges.
TITLE I--TAX PROVISIONS
SEC. 101. PUERTO RICO RESIDENTS ELIGIBLE FOR EARNED INCOME TAX CREDIT.
(a) In General.--Section 32 of the Internal Revenue Code of 1986 is
amended by adding at the end the following new subsection:
``(n) Residents of Puerto Rico.--
``(1) In general.--In the case of residents of Puerto
Rico--
``(A) the United States shall be treated as
including Puerto Rico for purposes of subsections
(c)(1)(A)(ii)(I) and (c)(3)(C),
``(B) subsection (c)(1)(D) shall not apply to
nonresident alien individuals who are residents of
Puerto Rico, and
``(C) adjusted gross income and gross income shall
be computed without regard to section 933 for purposes
of subsections (a)(2)(B) and (c)(2)(A)(i).
``(2) Limitation.--The credit allowed under this section by
reason of this subsection for any taxable year shall not exceed
the amount, determined under regulations or other guidance
promulgated by the Secretary, that a similarly situated
taxpayer would receive if residing in a State.''.
(b) Child Tax Credit Not Reduced.--Subclause (II) of section
24(d)(1)(B)(ii) of such Code is amended by inserting before the period
``(determined without regard to section 32(n) in the case of residents
of Puerto Rico)''.
(c) Effective Date.--The amendment made shall apply to taxable
years beginning after December 31, 2015.
SEC. 102. EQUITABLE TREATMENT FOR RESIDENTS OF PUERTO RICO WITH RESPECT
TO THE REFUNDABLE PORTION OF THE CHILD TAX CREDIT.
(a) In General.--Section 24(d)(1) of the Internal Revenue Code of
1986 is amended by inserting ``or section 933'' after ``section 112''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to taxable years beginning after December 31, 2015.
TITLE II--HEALTH CARE PARITY
Subtitle A--Medicaid
SEC. 201. ELIMINATION OF GENERAL MEDICAID FUNDING LIMITATIONS (``CAP'')
FOR TERRITORIES.
(a) In General.--Section 1108 of the Social Security Act (42 U.S.C.
1308) is amended--
(1) in subsection (f), in the matter before paragraph (1),
by striking ``subsection (g)'' and inserting ``subsections (g)
and (h)'';
(2) in subsection (g)(2), in the matter before subparagraph
(A), by inserting ``and subsection (h)'' after ``paragraphs (3)
and (5)''; and
(3) by adding at the end the following new subsection:
``(h) Sunset of Medicaid Funding Limitations for Puerto Rico, the
Virgin Islands of the United States, Guam, the Northern Mariana
Islands, and American Samoa.--Subsections (f) and (g) shall not apply
to Puerto Rico, the Virgin Islands of the United States, Guam, the
Northern Mariana Islands, and American Samoa beginning with fiscal year
2017.''.
(b) Conforming Amendments.--
(1) Section 1902(j) of the Social Security Act (42 U.S.C.
1396a(j)) is amended by striking ``, the limitation in section
1108(f),''.
(2) Section 1903(u) of the Social Security Act (42 U.S.C.
1396b(u)) is amended by striking paragraph (4).
(3) Section 1323(c)(1) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18043(c)(1)) is amended by
striking ``2019'' and inserting ``2016''.
(c) Effective Date.--The amendments made by this section shall
apply beginning with fiscal year 2017.
SEC. 202. ELIMINATION OF SPECIFIC FEDERAL MEDICAL ASSISTANCE PERCENTAGE
(FMAP) LIMITATION FOR TERRITORIES.
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(1) in subsection (b)(2), by inserting ``for fiscal years
before fiscal year 2017'' after ``American Samoa''; and
(2) in subsection (y)(1), in the matter preceding
subparagraph (A)--
(A) by inserting ``, for fiscal years before fiscal
year 2017,'' before ``is one of the''; and
(B) by inserting ``and, for fiscal year 2017 and
subsequent fiscal years, is one of the 50 States, the
District of Columbia, Puerto Rico, the Virgin Islands
of the United States, Guam, the Northern Mariana
Islands, or American Samoa,'' after ``the District of
Columbia''.
SEC. 203. APPLICATION OF MEDICAID WAIVER AUTHORITY TO ALL OF THE
TERRITORIES.
(a) In General.--Section 1902(j) of the Social Security Act (42
U.S.C. 1396a(j)) is amended--
(1) by striking ``American Samoa and the Northern Mariana
Islands'' and inserting ``Puerto Rico, the Virgin Islands of
the United States, Guam, the Northern Mariana Islands, and
American Samoa'';
(2) by striking ``American Samoa or the Northern Mariana
Islands'' and inserting ``Puerto Rico, the Virgin Islands of
the United States, Guam, the Northern Mariana Islands, or
American Samoa'';
(3) by inserting ``(1)'' after ``(j)'';
(4) by inserting ``except as otherwise provided in this
subsection,'' after ``Notwithstanding any other requirement of
this title''; and
(5) by adding at the end the following:
``(2) The Secretary may not waive under this subsection the
requirement of subsection (a)(10)(A)(i)(IX) (relating to coverage of
adults formerly under foster care) with respect to any territory.''.
(b) Effective Date.--The amendments made by this section shall
apply beginning October 1, 2016.
SEC. 204. APPLICATION OF 100 PERCENT FEDERAL POVERTY LINE (FPL)
LIMITATION TO TERRITORIES.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)(10)(A)(i)(VIII), by inserting ``(or,
subject to subsection (j), 100 percent in the case of Puerto
Rico, the Virgin Islands of the United States, Guam, the
Northern Mariana Islands, and American Samoa)'' after ``133
percent''; and
(2) in subsection (j), as amended by section 203, by adding
at the end the following new paragraph:
``(3)(A) Subject to subparagraph (B), Federal financial
participation shall not be available to Puerto Rico, the Virgin Islands
of the United States, Guam, the Northern Mariana Islands, or American
Samoa for medical assistance for an individual whose family income
exceeds 100 percent of the official poverty line for a family of the
size involved, except in the case of individuals qualifying for medical
assistance under subsection (a)(10)(A)(i)(IX).
``(B) The Secretary may, under paragraph (1) or section 1115, waive
the limitation under subparagraph (A) in the case of a territory other
than Puerto Rico. In carrying out this subparagraph, the Secretary
shall take into account the eligibility levels established under the
State plan of the territory involved before the date of the enactment
of this paragraph.''.
(b) Not Applying 5 Percent Disregard.--Section 1902(e)(14)(I) of
the Social Security Act (42 U.S.C. 1396b(e)(14)(I)) is amended by
adding at the end the following:
``The previous sentence shall only apply to a State
that is one of the 50 States or the District of
Columbia.''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to eligibility determinations made with respect to
items and services furnished on or after October 1, 2016.
SEC. 205. PERMITTING MEDICAID DSH ALLOTMENTS FOR TERRITORIES.
Section 1923(f) of the Social Security Act (42 U.S.C. 1396) is
amended--
(1) in paragraph (6), by adding at the end the following
new subparagraph:
``(C) Territories.--
``(i) Fiscal year 2017.--For fiscal year
2017, with respect to the territories of Puerto
Rico, the Virgin Islands of the United States,
Guam, the Northern Mariana Islands, and
American Samoa, the DSH allotment determined
for each such territory shall bear the same
ratio to $150,000,000 as the ratio of the
number of individuals who are low-income or
uninsured and residing in each such respective
territory (as estimated from time to time by
the Secretary) bears to the sums of the number
of such individuals residing in all of the
territories.
``(ii) Subsequent fiscal year.--For each
subsequent fiscal year, the DSH allotment for
each such territory is subject to an increase
or reduction in accordance with paragraphs (3)
and (7).'';
(2) in paragraph (7)(A), by striking clause (iv) and
redesignating clause (v) as clause (iv); and
(3) in paragraph (9), by inserting before the period at the
end the following: ``, and includes, beginning with fiscal year
2017, Puerto Rico, the Virgin Islands of the United States,
Guam, the Northern Mariana Islands, and American Samoa''.
Subtitle B--Medicare
SEC. 211. CALCULATION OF MEDICARE DSH PAYMENTS FOR IPPS HOSPITALS IN
PUERTO RICO.
Section 1886(d)(9)(D)(iii) of the Social Security Act (42 U.S.C.
1395ww(d)(9)(D)(iii)) is amended to read as follows:
``(iii) Subparagraph (F) (relating to disproportionate
share payments), including application of subsection (r),
except that for this purpose--
``(I) the sum described in clause (ii) of this
subparagraph shall be substituted for the sum referred
to in paragraph (5)(F)(ii)(I); and
``(II) for discharges occurring on or after October
1, 2015, subclause (I) of paragraph (5)(F)(vi) shall be
applied by substituting for the numerator described in
such subclause the number of subsection (d) Puerto Rico
hospital's patient days for the cost reporting period
involved which were made up of patients who (for such
days) were entitled to benefits under part A of this
title and were--
``(aa) entitled to supplementary security
income benefits (excluding any State
supplementation) under title XVI of this Act;
``(bb) eligible for medical assistance
under a State plan under title XIX; or
``(cc) receiving aid or assistance under
any plan of the State approved under title I,
X, XIV, or XVI.''.
SEC. 212. APPLICATION OF PART B DEEMED ENROLLMENT PROCESS TO RESIDENTS
OF PUERTO RICO; SPECIAL ENROLLMENT PERIOD AND LIMIT ON
LATE ENROLLMENT PENALTIES.
(a) Application of Part B Deemed Enrollment Process to Residents of
Puerto Rico.--Section 1837(f)(3) of the Social Security Act (42 U.S.C.
1395p(f)(3)) is amended by striking ``, exclusive of Puerto Rico''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to individuals whose initial enrollment period under section
1837(d) of the Social Security Act begins on or after the first day of
the effective month, specified by the Secretary of Health and Human
Services under section 1839(j)(1)(C) of such Act, as added by
subsection (c)(2).
(c) Transition Providing Special Enrollment Period and Limit on
Late Enrollment Penalties for Certain Medicare Beneficiaries.--Section
1839 of the Social Security Act (42 U.S.C. 1395r) is amended--
(1) in the first sentence of subsection (b), by inserting
``subject to section 1839(j)(2),'' after ``subsection (i)(4) or
(l) of section 1837,''; and
(2) by adding at the end the following new subsection:
``(j) Special Rules for Certain Residents of Puerto Rico.--
``(1) Special enrollment period, coverage period for
residents who are eligible but not enrolled.--
``(A) In general.--In the case of a transition
individual (as defined in paragraph (3)) who is not
enrolled under this part as of the day before the first
day of the effective month (as defined in subparagraph
(C)), the Secretary shall provide for a special
enrollment period under section 1837 of 7 months
beginning with such effective month during which the
individual may be enrolled under this part.
``(B) Coverage period.--In the case of such an
individual who enrolls during such special enrollment
period, the coverage period under section 1838 shall
begin on the first day of the second month after the
month in which the individual enrolls.
``(C) Effective month defined.--In this section,
the term `effective month' means a month, not earlier
than October 2016 and not later than January 2017,
specified by the Secretary.
``(2) Reduction in late enrollment penalties for current
enrollees and individuals enrolling during transition.--
``(A) In general.--In the case of a transition
individual who is enrolled under this part as of the
day before the first day of the effective month or who
enrolls under this part on or after the date of the
enactment of this subsection but before the end of the
special enrollment period under paragraph (1)(A), the
amount of the late enrollment penalty imposed under
section 1839(b) shall be recalculated by reducing the
penalty to 15 percent of the penalty otherwise
established.
``(B) Application.--Subparagraph (A) shall be
applied in the case of a transition individual who--
``(i) is enrolled under this part as of the
month before the effective month, for premiums
for months beginning with such effective month;
or
``(ii) enrolls under this part on or after
the date of the enactment of this Act and
before the end of the special enrollment period
under paragraph (1)(A), for premiums for months
during the coverage period under this part
which occur during or after the effective
month.
``(C) Loss of reduction if individual terminates
enrollment.--Subparagraph (A) shall not apply to a
transition individual if the individual terminates
enrollment under this part after the end of the special
enrollment period under paragraph (1).
``(3) Transition individual defined.--In this section, the
term `transition individual' means an individual who resides in
Puerto Rico and who would have been deemed enrolled under this
part pursuant to section 1837(f) before the first day of the
effective month but for the fact that the individual was a
resident of Puerto Rico, regardless of whether the individual
is enrolled under this part as of such first day.''.
SEC. 213. PUERTO RICO PRACTICE EXPENSE GPCI IMPROVEMENT.
Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)) is amended--
(1) in subparagraph (A), by striking ``and (I)'' and
inserting ``(I), and (J)''; and
(2) by adding at the end the following new subparagraph:
``(J) Floor for practice expense index for services
furnished in puerto rico.--
``(i) In general.--For purposes of payment
for services furnished in Puerto Rico in a year
(beginning with 2016), after calculating the
practice expense index in subparagraph (A)(i)
for Puerto Rico, if such index is below the
reference index (as defined in clause (ii)) for
the year, the Secretary shall increase such
index for Puerto Rico to equal the value of the
reference index for the year. The preceding
sentence shall not be applied in a budget
neutral manner.
``(ii) Reference index defined.--In this
subparagraph, the term `reference index' means,
with respect to a year, 0.800 or, if less, the
lowest practice expense index value for the
year for any area in the 50 States or the
District of Columbia.''.
SEC. 214. ADJUSTMENT IN BENCHMARK FOR LOW BASE PAYMENT COUNTIES IN
PUERTO RICO.
Section 1853(n) of the Social Security Act (42 U.S.C. 1395w-23(n))
is amended--
(1) in paragraph (1), by striking ``and (5)'' and inserting
``, (5), and (6)'';
(2) in paragraph (4), by striking ``In no case'' and
inserting ``Subject to paragraph (6), in no case''; and
(3) by adding at the end the following new paragraph:
``(6) Special rules for blended benchmark amount for
territories.--
``(A) In general.--Subject to paragraph (2), the
blended benchmark amount for an area in a territory for
a year (beginning with 2016) shall not be less than 80
percent of the national average of the base payment
amounts specified in subparagraph (2)(E) for such year
for areas within the 50 States and the District of
Columbia.
``(B) Limitation.--In no case shall the blended
benchmark amount for an area in a territory for a year
under subparagraph (A) exceed the lowest blended
benchmark amount for any area within the 50 States and
the District of Columbia for such year.''.
SEC. 215. ELIMINATING EXCLUSION OF PART D ELIGIBLE INDIVIDUALS RESIDING
IN TERRITORIES FROM ELIGIBILITY FOR PREMIUM AND COST-
SHARING SUBSIDIES.
(a) In General.--Section 1860D-14(a)(3) of the Social Security Act
(42 U.S.C. 1395w-114(a)(3)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i), by striking ``subject to subparagraph (F),'';
(2) in subparagraph (B)(v), in the matter preceding
subclause (I), by striking ``Subject to subparagraph (F), the
Secretary'' and inserting ``The Secretary'';
(3) in subparagraph (C), by adding at the end the following
new sentence: ``In the case of an individual who is not a
resident of the 50 States or the District of Columbia, the
poverty line (as such term is defined in clause (ii)) that
shall apply to such individual shall be the poverty line for
the 48 contiguous States and the District of Columbia.''; and
(4) by striking subparagraph (F).
(b) Application of Medicaid Provisions.--Section 1935 of the Social
Security Act (42 U.S.C. 1396u-5) is amended--
(1) in subsection (a), by striking ``subject to subsection
(e)'' in the matter preceding paragraph (1); and
(2) by striking subsection (e).
(c) Conforming Amendment.--Section 1108(f) of the Social Security
Act (42 U.S.C. 1308(f)) is amended by striking ``and section
1935(e)(1)(B)'' in the matter preceding clause (i).
(d) Effective Date.--The amendments made by this section shall take
effect on January 1, 2017.
SEC. 216. REPORT ON TREATMENT OF TERRITORIES UNDER MEDICARE PART D.
Paragraph (4) of section 1935(e) of the Social Security Act (42
U.S.C. 1396u-5(e)) is amended to read as follows:
``(4) Report on application of subsection.--
``(A) In general.--Not later than May 1, 2018, the
Secretary shall submit to Congress a report on the
application of this subsection during the period
beginning with fiscal year 2006 and ending with
December 31, 2017.
``(B) Information to be included in report.--Such
report shall include--
``(i) program guidance issued by the
Secretary to implement this subsection;
``(ii) for each of Puerto Rico, the Virgin
Islands of the United States, Guam, the
Northern Mariana Islands, and American Samoa,
information on the increased amount under
paragraph (3) and how the territory has applied
such amount, including the territory's program
design, expenditures, and number of individuals
(and dual-eligible individuals) assisted; and
``(iii) a description of the differences
between how such territories are treated under
part D of title XVIII and under this title
compared with the treatment of the 50 States
and the District of Columbia under such part
and this title for different fiscal years
within the period covered under the report.
``(C) Recommendations.--Such report shall include
recommendations for improving prescription drug
coverage for low-income individuals in each territory
identified in subparagraph (B)(ii), including
recommendations regarding each of the following
alternative approaches:
``(i) Adjusting the aggregate amount
specified in paragraph (3)(B).
``(ii) Allowing residents of the
territories to be subsidy eligible individuals
under section 1860D-14, notwithstanding
subsection (a)(3)(F) of such section, or
providing substantially equivalent low-income
prescription drug subsidies to such
residents.''.
Subtitle C--Miscellaneous
SEC. 221. REPORT ON EXCLUSION OF TERRITORIES FROM EXCHANGES.
(a) In General.--Not later than February 1, 2018, the Secretary of
Health and Human Services shall submit to Congress a report that
details the adverse impacts in each territory from the practical
exclusion of the territories from the provisions of part II of subtitle
D of title I of the Patient Protection and Affordable Care Act insofar
as such provisions provide for the establishment of an American Health
Benefit Exchange or the administration of a federally facilitated
Exchange in each State and in the District of Columbia for the purpose
of making health insurance more affordable and accessible for
individuals and small businesses.
(b) Information in Report.--The report shall include information on
the following:
(1) An estimate of the total number of uninsured and
underinsured individuals residing in each territory with
respect to health insurance coverage.
(2) A description of the number of health insurance issuers
in each territory and the health insurance plans these issuers
offer.
(3) An estimate of the number of individuals residing in
each territory who are denied premium and cost-sharing
assistance that would otherwise be available to them for
obtaining health insurance coverage through an Exchange if they
resided in one of the 50 States or in the District of Columbia.
(4) An estimate of the amount of Federal assistance
described in paragraph (3) that is not being made available to
residents of each territory.
(5) An estimate of the number of small employers in each
territory that would be eligible to purchase health insurance
coverage through a Small Business Health Options Program (SHOP)
Marketplace that would operate as part of an Exchange if the
employers were in one of the 50 States or in the District of
Columbia.
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