I

103D CONGRESS

2D SESSION H. R. 4047

To amend title XIX of the Social Security Act to improve the Federal

medical assistance percentage used under the medicaid program, and

for other purposes.

IN THE HOUSE OF REPRESENTATIVES

MARCH 16, 1994

Mrs. THURMAN (for herself, Ms. BROWN of Florida, Mr. BACCHUS of Florida,

Mr. BILIRAKIS, Mr. CANADY, Mr. DEUTSCH, Mrs. FOWLER, Mr. GIBBONS, Mr. GOSS, Mr. HASTINGS, Mr. HUTTO, Mr. JOHNSTON of Florida,

Mr. LEWIS of Florida, Mr. MCCOLLUM, Mr. DIAZ-BALART, Mrs. MEEK,

Mr. MICA, Mr. MILLER of Florida, Mr. PETERSON of Florida, Ms. ROSLEHTINEN, Mr. SHAW, Mr. STEARNS, and Mr. YOUNG of Florida) introduced the following bill; which was referred to the Committee on Energy

and Commerce

A BILL

To amend title XIX of the Social Security Act to improve

the Federal medical assistance percentage used under

the medicaid program, and for other purposes.

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 ‘‘Fairness in Medicaid

5 Funding Act of 1994’’.
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1 SEC. 2. CHANGE IN FEDERAL MEDICAL ASSISTANCE PER2 CENTAGE.

3 (a) IN GENERAL.—Subsection (b) of section 1905 of

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

5 to read as follows:

6 ‘‘(b)(1)(A) Except as provided in paragraph (3), the

7 term ‘Federal medical assistance percentage’ means, for

8 each of the 50 States and the District of Columbia, 100

9 percent reduced by the product of the applicable percent10 age (as defined in subparagraph (B)) and the ratio of—

11 ‘‘(i)(I) for each of the 50 States, the total tax12 able resources ratio (as defined in subparagraph

13 (C)) of the State, or

14 ‘‘(II) for the District of Columbia, the per cap15 ita income ratio (as defined in subparagraph (D)),

16 to—

17 ‘‘(ii) the population in poverty ratio (as defined

18 in subparagraph (E)) of the State or District.

19 ‘‘(B)(i) For purposes of this subsection, the term ‘ap20 plicable percentage’ means a percentage estimated by the

21 Secretary with the advice of the General Accounting Office

22 that, when applied under subparagraph (A), would result

23 in an amount of aggregate payments under section

24 1903(a) for calendar years 1994 through 1998 equal to

25 the amount of aggregate payments that would have been

26 made under such section for quarters in such years if this
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1 subsection were applied as in effect on the day before the

2 date of the enactment of the Medicaid Fairness in Fund3 ing Act of 1993.

4 ‘‘(ii) The applicable percentage estimated by the Sec5 retary under clause (i) shall continue to apply with respect

6 to quarters beginning after calendar year 1998.

7 ‘‘(C) For purposes of this subsection, the term ‘total

8 taxable resources ratio’ means—

9 ‘‘(i) an amount equal to the most recent 3-year

10 average of the total taxable resources of the State,

11 as determined by the Secretary of the Treasury, di12 vided by

13 ‘‘(ii) an amount equal to the sum of the 3-year

14 averages determined under clause (i) for each of the

15 50 States.

16 ‘‘(D) For purposes of this subsection, the term ‘per

17 capita income ratio’ means—

18 ‘‘(i) an amount equal to the most recent 3-year

19 average of the total personal income of the District

20 of Columbia, as determined in accordance with the

21 provisions of section 1101(a)(8)(B), divided by

22 ‘‘(ii) an amount equal to the total personal in23 come of the continental United States (including

24 Alaska) and Hawaii, as determined under section

25 1101(a)(8)(B).
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1 ‘‘(E) For purposes of this subsection, the term ‘popu2 lation in poverty ratio’ means—

3 ‘‘(i) an amount equal to the 3-year-average of

4 the number of individuals in the State (or the Dis5 trict of Columbia) whose family income is below the

6 income official poverty line (as defined by the Office

7 of Management and Budget and revised annually in

8 accordance with section 673(2) of the Omnibus

9 Budget Reconciliation Act of 1981), divided by

10 ‘‘(ii) an amount equal to the sum of the aver11 ages determined under clause (i) for the 50 States.

12 ‘‘(2) The Federal medical assistance percentage for

13 Puerto Rico, the Virgin Islands, Guam, the Northern Mar14 iana Islands, and American Samoa shall be 50 percent.

15 ‘‘(3)(A) Except as provided in subparagraph (B), the

16 Federal medical assistance percentage shall in no case be

17 less than 40 percent or greater than 83 percent.

18 ‘‘(B) The Federal medical assistance percentage shall

19 be 100 percent with respect to amounts expended as medi20 cal assistance for services which are received through an

21 Indian Health Service facility whether operated by the In22 dian Health Service or by an Indian tribe or tribal organi23 zation (as defined in section 4 of the Indian Health Care

24 Improvement Act).
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1 ‘‘(4) For purposes of any provision of law other than

2 a provision of this title, unless otherwise specifically pro3 vided, any reference to the ‘Federal medical assistance

4 percentage’ as defined in this section shall be considered

5 a reference to such term as defined under this subsection

6 as in effect on the day before the date of the enactment

7 of the Medicaid Fairness in Funding Act of 1993.’’.

8 (b) CONFORMING AMENDMENT.—Section 1118 of the

9 Social Security Act (42 U.S.C. 1318) is amended by strik10 ing ‘‘(as defined in section 1905)’’ and inserting ‘‘(as de11 fined in section 1905(b), as in effect on the day before

12 the date of the enactment of the Medicaid Fairness in

13 Funding Act of 1993)’’.

14 (c) EFFECTIVE DATE.—The amendments made by

15 this section shall apply to payments made to States with

16 respect to calendar quarters beginning on or after January

17 1, 1994.

18 SEC. 3. ADMINISTRATION EXPENDITURES.

19 (a) IN GENERAL.—Section 1903(a) of the Social Se20 curity Act (42 U.S.C. 1396b(a)) is amended—

21 (1) in paragraph (2)—

22 (A) in subparagraph (A), by striking ‘‘75

23 per centum’’ and inserting ‘‘the Federal medical

24 assistance percentage’’;
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1 (B) by striking subparagraph (B) and in2 serting the following new subparagraph:

3 ‘‘(B) with respect to amounts expended for

4 nursing aide training and competency evaluation

5 programs, and competency evaluation programs de6 scribed in section 1919(e)(1) (including the costs for

7 nurses aides to complete such competency evaluation

8 programs) regardless of whether the programs are

9 provided in or outside nursing facilities or the skill

10 of the personnel involved in such programs, an

11 amount equal to the Federal medical assistance per12 centage of so much of the sums expended during

13 such quarter (as found necessary by the Secretary

14 for the proper and efficient administration of the

15 State plan) as are attributable to such programs;

16 plus’’;

17 (C) in subparagraph (C), by striking ‘‘75

18 percent’’ and inserting ‘‘the Federal medical as19 sistance percentage’’; and

20 (D) by striking subparagraph (D) and in21 serting the following new subparagraph:

22 ‘‘(D) an amount equal to the Federal medical

23 assistance percentage of so much of the sums ex24 pended (as found necessary by the Secretary for the

25 proper and efficient administration of the State
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1 plan) as are attributable to State activities under

2 section 1919(g); plus’’;

3 (2) in paragraph (3)—

4 (A) in subparagraph (A)—

5 (i) by striking ‘‘(A)(i)’’ and inserting

6 ‘‘(A)’’;

7 (ii) by striking ‘‘90 per centum’’ and

8 inserting ‘‘the Federal medical assistance

9 percentage’’;

10 (iii) by striking ‘‘under this title, and’’

11 and inserting ‘‘under this title; plus’’; and

12 (iv) by striking clause (ii);

13 (B) in subparagraph (B), by striking ‘‘75

14 per centum’’ and inserting ‘‘the Federal medical

15 assistance percentage’’;

16 (C) in subparagraph (C), by striking ‘‘75

17 per centum’’ and inserting ‘‘the Federal medical

18 assistance percentage’’; and

19 (D) in subparagraph (D), by striking ‘‘75

20 percent’’ and inserting ‘‘the Federal medical as21 sistance percentage’’;

22 (3) in paragraph (4), by striking ‘‘100 percent’’

23 and inserting ‘‘the Federal medical assistance per24 centage’’;
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1 (4) in paragraph (5), by striking ‘‘90 per cen2 tum’’ and inserting ‘‘the Federal medical assistance

3 percentage’’;

4 (5) by striking paragraph (6) and inserting the

5 following new paragraph:

6 ‘‘(6) subject to subsection (b)(3), an amount

7 equal to the Federal medical assistance percentage

8 of the sums expended with respect to costs incurred

9 during such quarter (as found necessary by the Sec10 retary for the elimination of fraud in the provision

11 and administration of medical assistance provided

12 under the State plan) which are attributable to the

13 establishment and operation of (including the train14 ing of personnel employed by) a State medicaid

15 fraud control unit (described in subsection (q));

16 plus’’; and

17 (6) in paragraph (7), by striking ‘‘subject to

18 section 1919(g)(3)(B), an amount equal to 50 per

19 centum’’ and inserting ‘‘subject to section

20 1919(g)(3)(C), an amount equal to the Federal med21 ical assistance percentage’’.

22 (b) EFFECTIVE DATE.—The amendments made by

23 this section shall apply to payments made to States with

24 respect to calendar quarters beginning on or after January

25 1, 1994.
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