[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4406 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 4406
To amend titles XI and XIX of the Social Security Act to provide
increased financial support to the territories under the Medicaid
program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 13, 2021
Mr. Soto (for himself, Mr. Bilirakis, Mr. San Nicolas, Miss Gonzalez-
Colon, Mrs. Radewagen, Mr. Sablan, and Ms. Plaskett) 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 provide
increased financial support to the territories under the Medicaid
program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Supporting Medicaid in the U.S.
Territories Act of 2021''.
SEC. 2. EXTENDING THE INCREASED FEDERAL MEDICAL ASSISTANCE PERCENTAGE
AND CAP AMOUNTS FOR TERRITORIES.
(a) Federal Medical Assistance Percentage Extension.--
(1) In general.--Section 1905(ff) of the Social Security
Act (42 U.S.C. 1396d(ff)) is amended--
(A) in paragraph (2), by striking ``2021'' and
inserting ``2026''; and
(B) in paragraph (3), by striking ``2021'' and
inserting ``2029''.
(2) Ensuring program integrity.--Section 1108(g) of the
Social Security Act (42 U.S.C. 1308(g)) is amended--
(A) in paragraph (7)(B)(i), in the matter preceding
subclause (I), by striking ``2021'' and inserting
``2026''; and
(B) in paragraph (8)(B), by striking ``2021'' and
inserting ``2026''.
(b) Cap Amount Extension.--
(1) Puerto rico.--
(A) Ensuring increased cap amount in response to
covid-19.--Section 1108(g) of the Social Security Act
(42 U.S.C. 1308(g)) is amended--
(i) in paragraph (2)(A)(ii), by striking
``2021'' and inserting ``2026''; and
(ii) in paragraph (6)--
(I) in the header, by striking
``2021'' and inserting ``2026'';
(II) in subparagraph (A)--
(aa) in clause (i), by
striking ``and'' at the end;
and
(bb) in clause (ii)--
(AA) by striking
``fiscal year 2021''
and inserting ``each of
fiscal years 2021 and
2022''; and
(BB) by striking
the period and
inserting ``; and'';
and
(III) in subparagraph (B)--
(aa) in clause (i), by
striking ``2021'' and inserting
``2026''; and
(bb) in clause (ii)(II), by
striking ``2021'' and inserting
``2026''.
(B) Extension of cap amount for other years.--
Section 1108(g)(6)(A) of the Social Security Act (42
U.S.C. 1308(g)), as amended by subparagraph (A), is
further amended by adding at the end the following new
clause:
``(iii) for each of fiscal years 2023
through 2026, $2,719,072,000.''.
(2) Other territories.--
(A) Ensuring increased cap amounts in response to
covid-19.--Section 1108(g)(2) of the Social Security
Act (42 U.S.C. 1308(g)(2)) is amended in each of
subparagraphs (B)(iii), (C)(iii), (D)(iii), and
(E)(iii), by striking ``fiscal year 2021'' and
inserting ``each of fiscal years 2021 and 2022''.
(B) Extension of cap amounts for other years.--
Section 1108(g)(2) of the Social Security Act (42
U.S.C. 1308(g)(2)) is amended--
(i) in subparagraph (B)--
(I) in clause (i), by striking
``clause (ii)'' and inserting ``clauses
(ii) through (iv)'';
(II) in clause (ii), by striking
``and'' at the end;
(III) in clause (iii), by adding
``and'' at the end; and
(IV) by adding at the end the
following new clause:
``(iv) for each of fiscal years 2023
through 2029, $126,000,000;'';
(ii) in subparagraph (C)--
(I) in clause (i), by striking
``clause (ii)'' and inserting ``clauses
(ii) through (iv)'';
(II) in clause (ii), by striking
``and'' at the end;
(III) in clause (iii), by adding
``and'' at the end; and
(IV) by adding at the end the
following new clause:
``(iv) for each of fiscal years 2023
through 2029, $127,000,000;'';
(iii) in subparagraph (D)--
(I) in clause (i), by striking
``clause (ii)'' and inserting ``clauses
(ii) through (iv)'';
(II) in clause (ii), by striking
``and'' at the end;
(III) in clause (iii), by adding
``and'' at the end; and
(IV) by adding at the end the
following new clause:
``(iv) for each of fiscal years 2023
through 2029, $60,000,000; and''; and
(iv) in subparagraph (E)--
(I) in clause (i), by striking
``clause (ii)'' and inserting ``clauses
(ii) through (iv)'';
(II) in clause (ii), by striking
``and'' at the end;
(III) in clause (iii), by adding
``and'' at the end; and
(IV) by adding at the end the
following new clause:
``(iv) for each of fiscal years 2023
through 2029, $84,000,000.''.
(3) Modification of special rule for calculation of cap
amounts for certain years.--Section 1108(g)(2) of the Social
Security Act (42 U.S.C. 1308(g)(2)) is amended, in the matter
following subparagraph (E)--
(A) by striking ``fiscal year 2021'' and inserting
``fiscal year 2029 (or, in the case of Puerto Rico,
fiscal year 2026)'';
(B) by striking ``through 2021'' and inserting
``through 2029 (or, in the case of Puerto Rico,
2026)''; and
(C) by striking ``each such subparagraph'' and
inserting ``subparagraph (A) and any of clauses (ii)
through (iv) of subparagraphs (B) through (E)''.
(c) Application of Asset Verification Program Requirements to
Puerto Rico.--Section 1940 of the Social Security Act (42 U.S.C. 1396w)
is amended--
(1) in subsection (a)--
(A) in paragraph (3)(A), by adding at the end the
following new clause:
``(iii) Implementation in puerto rico.--The
Secretary shall require Puerto Rico to
implement an asset verification program under
this subsection by the end of fiscal year
2024.''; and
(B) in paragraph (4)--
(i) in the paragraph heading, by striking
``Exemption of territories'' and inserting
``Exemption of certain territories''; and
(ii) by striking ``and the District of
Columbia'' and inserting ``, the District of
Columbia, and Puerto Rico''; and
(2) in subsection (k)--
(A) in paragraph (1)--
(i) by redesignating subparagraphs (A)
through (D) as clauses (i) through (iv),
respectively, and adjusting the margins
accordingly;
(ii) in the matter preceding clause (i), as
so redesignated--
(I) by striking ``beginning on or
after January 1, 2021''; and
(II) by striking ``for a non-
compliant State shall be reduced--''
and inserting the following: ``for--
``(A) a non-compliant State that is one of the 50
States or the District of Columbia shall be reduced--
'';
(iii) in clause (iv), as so redesignated,
by striking the period at the end and inserting
``; and''; and
(iv) by adding at the end the following new
subparagraph:
``(B) a non-compliant State that is Puerto Rico
shall be reduced--
``(i) for calendar quarters in fiscal years
2025 and 2026, by 0.12 percentage points;
``(ii) for calendar quarters in fiscal year
2027, by 0.25 percentage points;
``(iii) for calendar quarters in fiscal
year 2028, by 0.35 percentage points; and
``(iv) for calendar quarters in fiscal year
2029 and each fiscal year thereafter, by 0.5
percentage points.''; and
(B) in paragraph (2)(A), by striking ``or the
District of Columbia'' and inserting ``the District of
Columbia, or Puerto Rico''.
(d) Extension of Reporting Requirement.--Section 1108(g)(9) of the
Social Security Act (42 U.S.C. 1308(g)(9)) is amended--
(1) in subparagraph (A), by striking ``2021'' and inserting
``2029''; and
(2) in subparagraph (B)(i), by inserting ``or by reason of
the amendments made by section 2 of the Supporting Medicaid in
the U.S. Territories Act of 2021'' before the period at the
end.
(e) Puerto Rico Program Integrity.--Section 1108(g)(7)(A) of the
Social Security Act (42 U.S.C. 1308(g)(7)(A)) is amended--
(1) in clause (iii), in the header, by inserting
``reporting'' after ``reform''; and
(2) by adding at the end the following new clauses:
``(v) Core set reporting compliance
report.--Not later than October 1, 2022, Puerto
Rico shall submit to the Chair and Ranking
Member of the Committee on Energy and Commerce
of the House of Representatives and the Chair
and Ranking Member of the Committee on Finance
of the Senate a report outlining steps being
taken by Puerto Rico to reach compliance with
the reporting requirements described in section
1139A(a)(4)(B) and section 1139B(b)(5)(C) and
describing what further actions are needed by
Puerto Rico in order to comply with such
requirements with respect to annual State
reports under section 1139A(c) and State
reports under section 1139B(d)(1) beginning
with fiscal year 2024.
``(vi) Contracting and procurement
oversight lead requirement.--
``(I) In general.--Not later than 6
months after the date of the enactment
of this clause, the agency responsible
for the administration of Puerto Rico's
Medicaid program under title XIX shall
designate an officer (other than the
director of such agency) to serve as
the Contracting and Procurement
Oversight Lead to carry out the duties
specified in subclause (II).
``(II) Duties.--Not later than 60
days after the end of each fiscal
quarter (beginning with the first
fiscal quarter beginning on or after
the date that is 1 year after the date
of the enactment of this clause), the
officer designated pursuant to
subclause (I) shall, with respect to
each contract described in clause (iii)
with an annual value exceeding $150,000
entered into during such quarter,
certify to the Secretary either--
``(aa) that such contract
has met the procurement
standards identified under any
of sections 75.327, 75.328, and
75.329 of title 45, Code of
Federal Regulations (or
successor regulations); or
``(bb) that extenuating
circumstances (including a lack
of multiple entities competing
for such contract) prevented
the compliance of such contract
with such standards.
``(III) Publication.--The officer
designated pursuant to subclause (I)
shall make public each certification
containing extenuating circumstances
described in subclause (II)(bb) not
later than 30 days after such
certification is made, including a
description of, and justification of,
such extenuating circumstances.
``(IV) Review of compliance.--Not
later than 2 years after the date of
the enactment of this clause, the
Inspector General of the Department of
Health and Human Services shall submit
to Congress a report on the compliance
of Puerto Rico with the provisions of
this clause.''.
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