[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1722 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 1722
To amend titles XI and XIX of the Social Security Act to stabilize the
Medicaid program in Puerto Rico.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 9, 2021
Ms. Velazquez (for herself, Mr. Espaillat, Ms. Ocasio-Cortez, Mr.
Garcia of Illinois, Mr. Grijalva, and Miss Gonzalez-Colon) introduced
the following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend titles XI and XIX of the Social Security Act to stabilize the
Medicaid program in Puerto Rico.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Puerto Rico Health Care Fairness,
Accountability, and Beneficiary Access Act of 2021''.
SEC. 2. ADJUSTMENTS TO FMAP AND CAP FOR PUERTO RICO.
(a) Adjustments to FMAP.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended--
(1) in subsection (b) by inserting ``(except for Puerto
Rico, for calendar quarters in a fiscal year beginning with
fiscal year 2022, shall be the PR specified percent under
subsection (hh) for such fiscal year)'' after ``shall be 55
percent''; and
(2) by adding at the end the following new subsection:
``(hh) PR Specified Percent.--
``(1) In general.--For purposes of subsection (b), the PR
specified percent under this subsection is--
``(A) subject to paragraph (2), for each of fiscal
years 2022 through 2026, 83 percent;
``(B) subject to paragraph (3)(D)(iii), for each of
fiscal years 2027 through 2031, 83 percent; and
``(C) subject to paragraph (3)(D)(iii), for fiscal
year 2032 and each subsequent fiscal year, the Federal
medical assistance percentage calculated in accordance
with the first sentence of subsection (b), as such
sentence applies to the 50 States.
``(2) Program Enhancement Incentives.--
``(A) In general.--If Puerto Rico--
``(i) for fiscal year 2023, is in compliance with
none of the program enhancement requirements described
in subparagraph (B), the PR specified percent specified
under paragraph (1) for such fiscal year shall be
reduced by 2 percent;
``(ii) for fiscal year 2024, is in compliance with
fewer than two of the four program enhancement
requirements described in subparagraph (B), the PR
specified percent specified under paragraph (1) for
such fiscal year shall be reduced by 3 percent;
``(iii) for fiscal year 2025, is in compliance with
fewer than three of the four program enhancement
requirements described in subparagraph (B), the PR
specified percent specified under paragraph (1) for
such fiscal year shall be reduced by 5 percent; and
``(iv) for fiscal year 2026, is in compliance with
fewer than four of the program enhancement requirements
described in subparagraph (B), the PR specified percent
specified under paragraph (1) for such fiscal year
shall be reduced by 5 percent.
``(B) Program enhancement requirements.--For purposes of
this subsection, the program enhancement requirements described
in this subparagraph are each of the following:
``(i) Rates of payment under the State plan under
this title for inpatient hospital services are not less
than the costs incurred for such services.
``(ii) Rates of payment under the State plan under
this title for physicians' services are not less than
70 percent of the amount that is payable for such
services under section 1848.
``(iii) The State plan provides for medical
assistance for Hepatitis C drugs, in accordance with
the requirements of section 1927 otherwise applicable
to the 50 States.
``(iv) The State plan provides for medical
assistance for Medicare cost-sharing described in
subsection (p)(3)(A)(ii) for qualified Medicare
beneficiaries described in subsection (p)(1), in
accordance with the requirements under subsection (p)
otherwise applicable to the 50 States.
``(3) Territory Transition Plan.--
``(A) In general.--
``(i) Submission of plan.--Not later than January
1, 2024, the Governor of Puerto Rico shall submit to
the Secretary a Territory Transition Plan, which shall
be developed with stakeholder input and with a public
comment period, that includes--
``(I) a detailed description of which
program enhancements described in subparagraph
(C) Puerto Rico will include as medical
assistance under the State plan under title
XIX, the first plan year by which each such
program enhancement will be so included in
order to satisfy the requirements described in
subparagraph (B), and a timeline for milestones
for including such program enhancements; and
``(II) a description of any challenges,
including infrastructure challenges, provider
shortages, and financing challenges, for so
including such program enhancements and a plan
to ameliorate any such challenges.
``(ii) Notification of plan approval.--The plan
submitted under clause (i) shall be treated as approved
by the Secretary not later than 180 days after the date
of submission of the plan unless within such 180-day
period the Secretary disapproves such plan and notifies
Puerto Rico of such disapproval with the reason for
such disapproval. In the case of such a disapproval,
the Governor of Puerto Rico shall, within the 90-day
period following such notification, submit to the
Secretary a Territory Transition Plan that addresses
the reason specified in such notification for such
disapproval. Such resubmitted plan shall be treated as
approved by the Secretary under this clause unless the
Secretary notifies Puerto Rico within the 30-day period
following such submission of its disapproval with a
reason for such disapproval. The Governor of Puerto
Rico may develop and submit to the Secretary, in the
same manner and subject to the same conditions as apply
under clause (i) to the development and submission of
the Territory Transition Plan, modifications to the
plan and such modifications shall be treated as
approved by the Secretary and incorporated into the
plan in the same manner and subject to the same
conditions that apply under this clause to the approval
of the plan.
``(B) Requirements described.--For purposes of this
paragraph, the requirements described in this subparagraph,
with respect to Puerto Rico, are the following:
``(i) For 2029, the State plan under title XIX
includes at least 2 of the program enhancements
described in subparagraph (C).
``(ii) For 2031, the State plan includes at least 4
of such program enhancements.
``(iii) For 2033, the State plan includes at least
6 of such program enhancements.
``(iv) For 2035 and each subsequent year, the State
plan includes all of such program enhancements.
``(C) Program enhancements described.--For purposes of this
paragraph, the program enhancements described in this
subparagraph are the following:
``(i) The State plan provides for medical
assistance to all individuals described in clause (i)
of section 1902(a)(10)(A)).
``(ii) The State plan provides for inclusion as
medical assistance of home health services, in
accordance with section 1902(a)(10)(D).
``(iii) The State plan provides for inclusion as
medical assistance of nonemergency transportation to
medically necessary services.
``(iv) The State plan provides for inclusion as
medical assistance of services described in subsection
(a)(21) to all individuals described in clause (i) of
section 1902(a)(10)(A)).
``(v) The State plan provides for inclusion as
medical assistance of services described in subsection
(a)(17) to all individuals described in such clause
(other than subclause (VIII) of such clause.
``(vi) The State plan provides for inclusion as
medical assistance of nursing facility services, as
defined in subsection (a)(4)(A).
``(vii) The State plan provides for inclusion as
medical assistance of early and periodic screening,
diagnosis, and treatment services under subsection
(a)(4)(B).
``(viii) The State plan provides for inclusion as
medical assistance of freestanding birth center
services and other ambulatory services, as described in
subsection (a)(28).
``(D) Reports.--
``(i) For fiscal year 2024 and each subsequent
fiscal year through fiscal year 2035--
``(I) the Comptroller General of the United
States shall review, and submit to the
Secretary and Congress a report on, whether or
not Puerto Rico is in compliance with the
timeline and achieving the milestones described
in the Territory Transition plan (as modified,
if applicable) approved under subparagraph (A)
and, beginning with fiscal year 2029, whether
Puerto Rico is in compliance with the
applicable requirements described in
subparagraph (B); and
``(II) Puerto Rico shall submit to the
Secretary a report on the extent to which
Puerto Rico has met the timelines and
milestones included in such plan (as modified,
if applicable).
``(ii) If, for a fiscal year described in clause
(i) after fiscal year 2026, the Comptroller General
submits a report with a finding that Puerto Rico is not
in compliance with the timeline or with achieving
milestones as described in subclause (I) (or, with
respect to a fiscal year after fiscal year 2028, not in
compliance with the applicable requirement under
subparagraph (B)), not later than 90 days after the
date of such finding, Puerto Rico shall submit to the
Secretary for approval a corrective action plan to
remedy such noncompliance.
``(iii) If, by not later than a period specified by
the Secretary after the date of the submission (and
approval) of a corrective action plan under clause
(ii), with respect to a fiscal year after fiscal year
2026 for which a finding of non-compliance was made
under clause (i), the Secretary determines that Puerto
Rico has not fulfilled the terms of such corrective
action plan, the PR specified percent specified under
paragraph (1) for the fiscal year involved shall be
reduced by 5 percent for the period beginning with the
month beginning after such determination and ending
with the first month beginning after the Secretary
determines Puerto Rico has fulfilled the terms of the
corrective action plan.''.
(b) Treatment of Cap.--Section 1108(g) of the Social Security Act
(42 U.S.C. 1308(g)) is amended--
(1) in paragraph (2)--
(A) in the matter preceding subparagraph (A), by
striking ``subject to and section 1323(a)(2) of the
Patient Protection and Affordable Care Act paragraphs
(3) and (5)'' and inserting ``subject to section
1323(a)(2) of the Patient Protection and Affordable
Care Act and paragraphs (3), (5), and (7)''; and
(B) in subparagraph (A)--
(i) by striking ``Puerto Rico shall not
exceed the sum of'' and inserting ``Puerto Rico
shall not exceed--
``(i) in the case of a fiscal year before
fiscal year 2022, the sum of'';
(ii) by striking ``$100,000;'' and
inserting ``$100,000; and''; and
(iii) by adding at the end the following
new clause:
``(ii) in the case of fiscal year 2022 and
each subsequent fiscal year (before fiscal year
2027), the amount specified in paragraph (6)
for such fiscal year;''; and
(2) by adding at the end the following new paragraphs:
``(6) Application to puerto rico for fiscal years 2022
through 2026.--For purposes of paragraph (2)(A)(ii), the amount
specified in this paragraph is--
``(A) for fiscal year 2022, $3,012,610,000;
``(B) for fiscal year 2023, $3,114,331,000;
``(C) for fiscal year 2024, $3,225,627,000;
``(D) for fiscal year 2025, $3,336,627,000; and
``(E) for fiscal year 2026, $3,447,627,000.
``(7) Puerto rico exclusion from payment limitation
beginning fiscal year 2027.--Beginning with fiscal year 2027,
there shall be no limitation applied under this subsection (f)
or this subsection on the total amount certified by the
Secretary under title XIX for payment to Puerto Rico.''.
(c) Temporary Increase in Federal Match for State Plan
Administrative Costs.--Section 1903(a)(7) of the Social Security Act
(42 U.S.C. 1396b(a)(7)) is amended by inserting ``(or, in the case of
Puerto Rico for each of fiscal years 2022 through 2035, 100 percent)''
after ``50 per centum''.
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