I 

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. VELA ́ZQUEZ (for herself, Mr. ESPAILLAT, Ms. OCASIO-CORTEZ, Mr. 

GARCI ́A of Illinois, Mr. GRIJALVA, and Miss GONZA ́LEZ-COLO ́N) 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Puerto Rico Health 

5 Care Fairness, Accountability, and Beneficiary Access Act 

6 of 2021’’. 


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1 SEC. 2. ADJUSTMENTS TO FMAP AND CAP FOR PUERTO 

2 RICO. 

3 (a) ADJUSTMENTS TO FMAP.—Section 1905 of the 

4 Social Security Act (42 U.S.C. 1396d) is amended— 

5 (1) in subsection (b) by inserting ‘‘(except for 

6 Puerto Rico, for calendar quarters in a fiscal year 

7 beginning with fiscal year 2022, shall be the PR 

8 specified percent under subsection (hh) for such fis9 cal year)’’ after ‘‘shall be 55 percent’’; and 

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘(hh) PR SPECIFIED PERCENT.— 

13 ‘‘(1) IN GENERAL.—For purposes of subsection 

14 (b), the PR specified percent under this subsection 

15 is— 

16 ‘‘(A) subject to paragraph (2), for each of 

17 fiscal years 2022 through 2026, 83 percent; 

18 ‘‘(B) subject to paragraph (3)(D)(iii), for 

19 each of fiscal years 2027 through 2031, 83 per20 cent; and 

21 ‘‘(C) subject to paragraph (3)(D)(iii), for 

22 fiscal year 2032 and each subsequent fiscal 

23 year, the Federal medical assistance percentage 

24 calculated in accordance with the first sentence 

25 of subsection (b), as such sentence applies to 

26 the 50 States. 


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1 ‘‘(2) PROGRAM ENHANCEMENT INCENTIVES.— 

2 ‘‘(A) IN GENERAL.—If Puerto Rico— 

3 ‘‘(i) for fiscal year 2023, is in compliance 

4 with none of the program enhancement require5 ments described in subparagraph (B), the PR 

6 specified percent specified under paragraph (1) 

7 for such fiscal year shall be reduced by 2 per8 cent; 

9 ‘‘(ii) for fiscal year 2024, is in compliance 

10 with fewer than two of the four program en11 hancement requirements described in subpara12 graph (B), the PR specified percent specified 

13 under paragraph (1) for such fiscal year shall 

14 be reduced by 3 percent; 

15 ‘‘(iii) for fiscal year 2025, is in compliance 

16 with fewer than three of the four program en17 hancement requirements described in subpara18 graph (B), the PR specified percent specified 

19 under paragraph (1) for such fiscal year shall 

20 be reduced by 5 percent; and 

21 ‘‘(iv) for fiscal year 2026, is in compliance 

22 with fewer than four of the program enhance23 ment requirements described in subparagraph 

24 (B), the PR specified percent specified under 


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1 paragraph (1) for such fiscal year shall be re2 duced by 5 percent. 

3 ‘‘(B) PROGRAM ENHANCEMENT REQUIRE4 MENTS.—For purposes of this subsection, the pro5 gram enhancement requirements described in this 

6 subparagraph are each of the following: 

7 ‘‘(i) Rates of payment under the State 

8 plan under this title for inpatient hospital serv9 ices are not less than the costs incurred for 

10 such services. 

11 ‘‘(ii) Rates of payment under the State 

12 plan under this title for physicians’ services are 

13 not less than 70 percent of the amount that is 

14 payable for such services under section 1848. 

15 ‘‘(iii) The State plan provides for medical 

16 assistance for Hepatitis C drugs, in accordance 

17 with the requirements of section 1927 otherwise 

18 applicable to the 50 States. 

19 ‘‘(iv) The State plan provides for medical 

20 assistance for Medicare cost-sharing described 

21 in subsection (p)(3)(A)(ii) for qualified Medi22 care beneficiaries described in subsection (p)(1), 

23 in accordance with the requirements under sub24 section (p) otherwise applicable to the 50 

25 States. 


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1 ‘‘(3) TERRITORY TRANSITION PLAN.— 

2 ‘‘(A) IN GENERAL.— 

3 ‘‘(i) SUBMISSION OF PLAN.—Not later 

4 than January 1, 2024, the Governor of Puerto 

5 Rico shall submit to the Secretary a Territory 

6 Transition Plan, which shall be developed with 

7 stakeholder input and with a public comment 

8 period, that includes— 

9 ‘‘(I) a detailed description of which 

10 program enhancements described in sub11 paragraph (C) Puerto Rico will include as 

12 medical assistance under the State plan 

13 under title XIX, the first plan year by 

14 which each such program enhancement will 

15 be so included in order to satisfy the re16 quirements described in subparagraph (B), 

17 and a timeline for milestones for including 

18 such program enhancements; and 

19 ‘‘(II) a description of any challenges, 

20 including infrastructure challenges, pro21 vider shortages, and financing challenges, 

22 for so including such program enhance23 ments and a plan to ameliorate any such 

24 challenges. 


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1 ‘‘(ii) NOTIFICATION OF PLAN APPROVAL.— 

2 The plan submitted under clause (i) shall be 

3 treated as approved by the Secretary not later 

4 than 180 days after the date of submission of 

5 the plan unless within such 180-day period the 

6 Secretary disapproves such plan and notifies 

7 Puerto Rico of such disapproval with the reason 

8 for such disapproval. In the case of such a dis9 approval, the Governor of Puerto Rico shall, 

10 within the 90-day period following such notifi11 cation, submit to the Secretary a Territory 

12 Transition Plan that addresses the reason spec13 ified in such notification for such disapproval. 

14 Such resubmitted plan shall be treated as ap15 proved by the Secretary under this clause un16 less the Secretary notifies Puerto Rico within 

17 the 30-day period following such submission of 

18 its disapproval with a reason for such dis19 approval. The Governor of Puerto Rico may de20 velop and submit to the Secretary, in the same 

21 manner and subject to the same conditions as 

22 apply under clause (i) to the development and 

23 submission of the Territory Transition Plan, 

24 modifications to the plan and such modifica25 tions shall be treated as approved by the SecVerDate Sep 11 2014 19:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1722.IH H1722

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1 retary and incorporated into the plan in the 

2 same manner and subject to the same condi3 tions that apply under this clause to the ap4 proval of the plan. 

5 ‘‘(B) REQUIREMENTS DESCRIBED.—For pur6 poses of this paragraph, the requirements described 

7 in this subparagraph, with respect to Puerto Rico, 

8 are the following: 

9 ‘‘(i) For 2029, the State plan under title 

10 XIX includes at least 2 of the program en11 hancements described in subparagraph (C). 

12 ‘‘(ii) For 2031, the State plan includes at 

13 least 4 of such program enhancements. 

14 ‘‘(iii) For 2033, the State plan includes at 

15 least 6 of such program enhancements. 

16 ‘‘(iv) For 2035 and each subsequent year, 

17 the State plan includes all of such program en18 hancements. 

19 ‘‘(C) PROGRAM ENHANCEMENTS DESCRIBED.— 

20 For purposes of this paragraph, the program en21 hancements described in this subparagraph are the 

22 following: 

23 ‘‘(i) The State plan provides for medical 

24 assistance to all individuals described in clause 

25 (i) of section 1902(a)(10)(A)). 


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1 ‘‘(ii) The State plan provides for inclusion 

2 as medical assistance of home health services, 

3 in accordance with section 1902(a)(10)(D). 

4 ‘‘(iii) The State plan provides for inclusion 

5 as medical assistance of nonemergency trans6 portation to medically necessary services. 

7 ‘‘(iv) The State plan provides for inclusion 

8 as medical assistance of services described in 

9 subsection (a)(21) to all individuals described in 

10 clause (i) of section 1902(a)(10)(A)). 

11 ‘‘(v) The State plan provides for inclusion 

12 as medical assistance of services described in 

13 subsection (a)(17) to all individuals described in 

14 such clause (other than subclause (VIII) of 

15 such clause. 

16 ‘‘(vi) The State plan provides for inclusion 

17 as medical assistance of nursing facility serv18 ices, as defined in subsection (a)(4)(A). 

19 ‘‘(vii) The State plan provides for inclusion 

20 as medical assistance of early and periodic 

21 screening, diagnosis, and treatment services 

22 under subsection (a)(4)(B). 

23 ‘‘(viii) The State plan provides for inclu24 sion as medical assistance of freestanding birth 


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1 center services and other ambulatory services, 

2 as described in subsection (a)(28). 

3 ‘‘(D) REPORTS.— 

4 ‘‘(i) For fiscal year 2024 and each subse5 quent fiscal year through fiscal year 2035— 

6 ‘‘(I) the Comptroller General of the 

7 United States shall review, and submit to 

8 the Secretary and Congress a report on, 

9 whether or not Puerto Rico is in compli10 ance with the timeline and achieving the 

11 milestones described in the Territory Tran12 sition plan (as modified, if applicable) ap13 proved under subparagraph (A) and, be14 ginning with fiscal year 2029, whether 

15 Puerto Rico is in compliance with the ap16 plicable requirements described in subpara17 graph (B); and 

18 ‘‘(II) Puerto Rico shall submit to the 

19 Secretary a report on the extent to which 

20 Puerto Rico has met the timelines and 

21 milestones included in such plan (as modi22 fied, if applicable). 

23 ‘‘(ii) If, for a fiscal year described in clause 

24 (i) after fiscal year 2026, the Comptroller Gen25 eral submits a report with a finding that Puerto 


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1 Rico is not in compliance with the timeline or 

2 with achieving milestones as described in sub3 clause (I) (or, with respect to a fiscal year after 

4 fiscal year 2028, not in compliance with the ap5 plicable requirement under subparagraph (B)), 

6 not later than 90 days after the date of such 

7 finding, Puerto Rico shall submit to the Sec8 retary for approval a corrective action plan to 

9 remedy such noncompliance. 

10 ‘‘(iii) If, by not later than a period speci11 fied by the Secretary after the date of the sub12 mission (and approval) of a corrective action 

13 plan under clause (ii), with respect to a fiscal 

14 year after fiscal year 2026 for which a finding 

15 of non-compliance was made under clause (i), 

16 the Secretary determines that Puerto Rico has 

17 not fulfilled the terms of such corrective action 

18 plan, the PR specified percent specified under 

19 paragraph (1) for the fiscal year involved shall 

20 be reduced by 5 percent for the period begin21 ning with the month beginning after such deter22 mination and ending with the first month be23 ginning after the Secretary determines Puerto 

24 Rico has fulfilled the terms of the corrective ac25 tion plan.’’. 


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1 (b) TREATMENT OF CAP.—Section 1108(g) of the 

2 Social Security Act (42 U.S.C. 1308(g)) is amended— 

3 (1) in paragraph (2)— 

4 (A) in the matter preceding subparagraph 

5 (A), by striking ‘‘subject to and section 

6 1323(a)(2) of the Patient Protection and Af7 fordable Care Act paragraphs (3) and (5)’’ and 

8 inserting ‘‘subject to section 1323(a)(2) of the 

9 Patient Protection and Affordable Care Act and 

10 paragraphs (3), (5), and (7)’’; and 

11 (B) in subparagraph (A)— 

12 (i) by striking ‘‘Puerto Rico shall not 

13 exceed the sum of’’ and inserting ‘‘Puerto 

14 Rico shall not exceed— 

15 ‘‘(i) in the case of a fiscal year before 

16 fiscal year 2022, the sum of’’; 

17 (ii) by striking ‘‘$100,000;’’ and in18 serting ‘‘$100,000; and’’; and 

19 (iii) by adding at the end the fol20 lowing new clause: 

21 ‘‘(ii) in the case of fiscal year 2022 

22 and each subsequent fiscal year (before fis23 cal year 2027), the amount specified in 

24 paragraph (6) for such fiscal year;’’; and 


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1 (2) by adding at the end the following new 

2 paragraphs: 

3 ‘‘(6) APPLICATION TO PUERTO RICO FOR FIS4 CAL YEARS 2022 THROUGH 2026.—For purposes of 

5 paragraph (2)(A)(ii), the amount specified in this 

6 paragraph is— 

7 ‘‘(A) for fiscal year 2022, $3,012,610,000; 

8 ‘‘(B) for fiscal year 2023, $3,114,331,000; 

9 ‘‘(C) for fiscal year 2024, $3,225,627,000; 

10 ‘‘(D) for fiscal year 2025, $3,336,627,000; 

11 and 

12 ‘‘(E) for fiscal year 2026, $3,447,627,000. 

13 ‘‘(7) PUERTO RICO EXCLUSION FROM PAYMENT

14 LIMITATION BEGINNING FISCAL YEAR 2027.—Begin15 ning with fiscal year 2027, there shall be no limita16 tion applied under this subsection (f) or this sub17 section on the total amount certified by the Sec18 retary under title XIX for payment to Puerto 

19 Rico.’’. 

20 (c) TEMPORARY INCREASE IN FEDERAL MATCH FOR

21 STATE PLAN ADMINISTRATIVE COSTS.—Section 

22 1903(a)(7) of the Social Security Act (42 U.S.C. 

23 1396b(a)(7)) is amended by inserting ‘‘(or, in the case of 


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1 Puerto Rico for each of fiscal years 2022 through 2035, 

2 100 percent)’’ after ‘‘50 per centum’’. 

Æ 


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