II 

115TH CONGRESS 

1ST SESSION S. 2026 

To amend titles XVIII and XIX of the Social Security Act to make improvements to the treatment of the United States territories under the Medicare and Medicaid programs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 26, 2017 

Mr. NELSON (for himself, Mrs. GILLIBRAND, Mr. BLUMENTHAL, Mr. MENENDEZ, and Mr. BOOKER) introduced the following bill; which was read 

twice and referred to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to make improvements to the treatment of the United 

States territories under the Medicare and Medicaid programs, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Improving the Treatment of the U.S. Territories Under 

6 Federal Health Programs Act of 2017’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—MEDICAID 

Sec. 101. Elimination of general Medicaid funding limitations (‘‘cap’’) for territories. 

Sec. 102. Elimination of specific Federal medical assistance percentage 

(FMAP) limitation for territories. 

Sec. 103. Application of Medicaid waiver authority to all of the territories. 

Sec. 104. Permitting Medicaid DSH allotments for territories. 

TITLE II—MEDICARE 

Subtitle A—Part A 

Sec. 201. Calculation of Medicare DSH payments for IPPS hospitals in Puerto 

Rico. 

Sec. 202. Rebasing Target Amount for Hospitals in Territories. 

Sec. 203. Medicare DSH Target Adjustment for Hospitals in Territories. 

Subtitle B—Part B 

Sec. 211. Application of part B deemed enrollment process to residents of 

Puerto Rico; special enrollment period and limit on late enrollment penalties. 

Subtitle C—Medicare Advantage (Part C) 

Sec. 221. Adjustment in benchmark for low base payment counties in Puerto 

Rico. 

Subtitle D—Part D 

Sec. 231. Eliminating exclusion of part D eligible individuals residing in territories from eligibility for premium and cost-sharing subsidies. 

Sec. 232. Report on treatment of territories under Medicare part D. 

TITLE III—MISCELLANEOUS 

Sec. 301. Report on exclusion of territories from Exchanges. 

Sec. 302. Medicaid and CHIP territory transparency and information. 

1 TITLE I—MEDICAID 

2 SEC. 101. ELIMINATION OF GENERAL MEDICAID FUNDING 

3 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES. 

4 (a) IN GENERAL.—Section 1108 of the Social Secu5 rity Act (42 U.S.C. 1308) is amended— 

6 (1) in subsection (f), in the matter before para7 graph (1), by striking ‘‘subsection (g)’’ and inserting 

8 ‘‘subsections (g) and (h)’’; 


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1 (2) in subsection (g)(2), in the matter before 

2 subparagraph (A), by inserting ‘‘and subsection (h)’’ 

3 after ‘‘paragraphs (3) and (5)’’; and 

4 (3) by adding at the end the following new sub5 section: 

6 ‘‘(h) SUNSET OF MEDICAID FUNDING LIMITATIONS

7 FOR PUERTO RICO, THE VIRGIN ISLANDS OF THE

8 UNITED STATES, GUAM, THE NORTHERN MARIANA IS9 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 

10 shall not apply to Puerto Rico, the Virgin Islands of the 

11 United States, Guam, the Northern Mariana Islands, and 

12 American Samoa beginning with fiscal year 2018.’’. 

13 (b) CONFORMING AMENDMENTS.— 

14 (1) Section 1902(j) of the Social Security Act 

15 (42 U.S.C. 1396a(j)) is amended by striking ‘‘, the 

16 limitation in section 1108(f),’’. 

17 (2) Section 1903(u) of the Social Security Act 

18 (42 U.S.C. 1396b(u)) is amended by striking para19 graph (4). 

20 (3) Section 1323(c)(1) of the Patient Protection 

21 and Affordable Care Act (42 U.S.C. 18043(c)(1)) is 

22 amended by striking ‘‘2019’’ and inserting ‘‘2018’’. 

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

24 this section shall apply beginning with fiscal year 2018. 


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1 SEC. 102. ELIMINATION OF SPECIFIC FEDERAL MEDICAL 

2 ASSISTANCE PERCENTAGE (FMAP) LIMITA3 TION FOR TERRITORIES. 

4 Section 1905 of the Social Security Act (42 U.S.C. 

5 1396d) is amended— 

6 (1) in subsection (b)(2), by inserting ‘‘for fiscal 

7 years before fiscal year 2018’’ after ‘‘American 

8 Samoa’’; and 

9 (2) in subsection (y)(1), in the matter preceding 

10 subparagraph (A)— 

11 (A) by inserting ‘‘, for fiscal years before 

12 fiscal year 2018,’’ before ‘‘is one of the’’; and 

13 (B) by inserting ‘‘and, for fiscal year 2018 

14 and subsequent fiscal years, is one of the 50 

15 States, the District of Columbia, Puerto Rico, 

16 the Virgin Islands of the United States, Guam, 

17 the Northern Mariana Islands, or American 

18 Samoa,’’ after ‘‘the District of Columbia’’. 

19 SEC. 103. APPLICATION OF MEDICAID WAIVER AUTHORITY 

20 TO ALL OF THE TERRITORIES. 

21 (a) IN GENERAL.—Section 1902(j) of the Social Se22 curity Act (42 U.S.C. 1396a(j)) is amended— 

23 (1) by striking ‘‘American Samoa and the 

24 Northern Mariana Islands’’ and inserting ‘‘Puerto 

25 Rico, the Virgin Islands of the United States, Guam, 


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1 the Northern Mariana Islands, and American 

2 Samoa’’; 

3 (2) by striking ‘‘American Samoa or the North4 ern Mariana Islands’’ and inserting ‘‘Puerto Rico, 

5 the Virgin Islands of the United States, Guam, the 

6 Northern Mariana Islands, or American Samoa’’; 

7 (3) by striking ‘‘, the limitation in section 

8 1108(f),’’; 

9 (4) by inserting ‘‘(1)’’ after ‘‘(j)’’; 

10 (5) by inserting ‘‘except as otherwise provided 

11 in this subsection,’’ after ‘‘Notwithstanding any 

12 other requirement of this title’’; and 

13 (6) by adding at the end the following: 

14 ‘‘(2) The Secretary may not waive under this sub15 section the requirement of subsection (a)(10)(A)(i)(IX) 

16 (relating to coverage of adults formerly under foster care) 

17 with respect to any territory.’’. 

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

19 this section shall apply beginning October 1, 2017. 

20 SEC. 104. PERMITTING MEDICAID DSH ALLOTMENTS FOR 

21 TERRITORIES. 

22 Section 1923(f) of the Social Security Act (42 U.S.C. 

23 1396) is amended— 

24 (1) in paragraph (6), by adding at the end the 

25 following new subparagraph: 


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1 ‘‘(C) TERRITORIES.— 

2 ‘‘(i) FISCAL YEAR 2018.—For fiscal 

3 year 2018, with respect to the territories of 

4 Puerto Rico, the Virgin Islands of the 

5 United States, Guam, the Northern Mar6 iana Islands, and American Samoa, the 

7 DSH allotment determined for each such 

8 territory shall bear the same ratio to 

9 $150,000,000 as the ratio of the number 

10 of individuals who are low-income or unin11 sured and residing in each such respective 

12 territory (as estimated from time to time 

13 by the Secretary) bears to the sums of the 

14 number of such individuals residing in all 

15 of the territories. 

16 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 

17 For each subsequent fiscal year, the DSH 

18 allotment for each such territory is subject 

19 to an increase or reduction in accordance 

20 with paragraphs (3) and (7).’’; 

21 (2) in paragraph (7)(A), by striking clause (iv) 

22 and redesignating clause (v) as clause (iv); and 

23 (3) in paragraph (9), by inserting before the pe24 riod at the end the following: ‘‘, and includes, begin25 ning with fiscal year 2018, Puerto Rico, the Virgin 


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1 Islands of the United States, Guam, the Northern 

2 Mariana Islands, and American Samoa’’. 

3 TITLE II—MEDICARE 

4 Subtitle A—Part A 

5 SEC. 201. CALCULATION OF MEDICARE DSH PAYMENTS FOR 

6 IPPS HOSPITALS IN PUERTO RICO. 

7 Section 1886(d)(9)(D)(iii) of the Social Security Act 

8 (42 U.S.C. 1395ww(d)(9)(D)(iii)) is amended to read as 

9 follows: 

10 ‘‘(iii) Subparagraph (F) (relating to dispropor11 tionate share payments), including application of 

12 subsection (r), except that for this purpose— 

13 ‘‘(I) the sum described in clause (ii) of this 

14 subparagraph shall be substituted for the sum 

15 referred to in paragraph (5)(F)(ii)(I); and 

16 ‘‘(II) for discharges occurring on or after 

17 October 1, 2017, subclause (I) of paragraph 

18 (5)(F)(vi) shall be applied by substituting for 

19 the numerator described in such subclause the 

20 number of subsection (d) Puerto Rico hospital’s 

21 patient days for the cost reporting period in22 volved which were made up of patients who (for 

23 such days) were entitled to benefits under part 

24 A of this title and were— 


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1 ‘‘(aa) entitled to supplementary secu2 rity income benefits (excluding any State 

3 supplementation) under title XVI of this 

4 Act; 

5 ‘‘(bb) eligible for medical assistance 

6 under a State plan under title XIX; or 

7 ‘‘(cc) receiving aid or assistance under 

8 any plan of the State approved under title 

9 I, X, XIV, or XVI.’’. 

10 SEC. 202. REBASING TARGET AMOUNT FOR HOSPITALS IN 

11 TERRITORIES. 

12 Section 1886(b)(3) of the Social Security Act (42 

13 U.S.C. 1395ww(b)(3)) is amended by adding at the end 

14 the following new subparagraph: 

15 ‘‘(M)(i) For each cost reporting period be16 ginning on or after October 1, 2017, in the case 

17 of a hospital located in a territory of the United 

18 States, there shall be substituted for the target 

19 amount otherwise determined under subpara20 graph (A) the rebased target amount (as de21 fined in clause (ii)), if such substitution results 

22 in an amount of payment under this section to 

23 the hospital for such period that is greater than 

24 the amount of payment that would be made 


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1 under this section to the hospital for such pe2 riod if this subparagraph were not to apply. 

3 ‘‘(ii) For purposes of this subparagraph, 

4 the term ‘rebased target amount’ has the mean5 ing given the term ‘target amount’ in subpara6 graph (A), except that— 

7 ‘‘(I) there shall be substituted for the 

8 base cost reporting period the 12-month 

9 cost reporting period beginning during fis10 cal year 2015; 

11 ‘‘(II) any reference in subparagraph 

12 (A)(i) to the ‘first such cost reporting pe13 riod’ is deemed a reference to the first cost 

14 reporting period beginning on or after Oc15 tober 1, 2017; and 

16 ‘‘(III) the applicable percentage in17 crease shall only be applied under subpara18 graph (B)(ii) for cost reporting periods be19 ginning on or after October 1, 2017. 

20 ‘‘(iii) Nothing in this subparagraph shall 

21 affect any rebasing request by a hospital for 

22 any cost reporting period beginning during a 

23 fiscal year before fiscal year 2015.’’. 


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1 SEC. 203. MEDICARE DSH TARGET ADJUSTMENT FOR HOS2 PITALS IN TERRITORIES. 

3 Section 1886(b)(3) of the Social Security Act (42 

4 U.S.C. 1395ww(b)(3)), as amended by section 202, is fur5 ther amended by adding at the end the following new sub6 paragraph: 

7 ‘‘(N)(i) For each cost reporting period be8 ginning on or after October 1, 2017, in the case 

9 of a hospital that is located in a territory of the 

10 United States other than Puerto Rico and that 

11 would be a subsection (d) hospital if it were lo12 cated in one of the 50 States, the target 

13 amount shall be increased by— 

14 ‘‘(I) in the case that such hospital has 

15 a disproportionate patient percentage of 

16 not less than 15 percent and not greater 

17 than 40 percent, 10 percent; and 

18 ‘‘(II) in the case that such hospital 

19 has a disproportionate patient percentage 

20 of greater than 40 percent, 10 percent plus 

21 60 percent of the number of percentage 

22 points by which such hospital’s dispropor23 tionate patient percentage exceeds 40 per24 cent. 

25 ‘‘(ii) For purposes of this subparagraph, 

26 the term ‘disproportionate patient percentage’ 


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1 has the meaning given such term in subsection 

2 (d)(5)(F)(vi), except that in applying such 

3 meaning any reference under such subsection to 

4 individuals entitled to supplementary security 

5 income under title XVI shall be deemed for pur6 poses of this subparagraph to include individ7 uals— 

8 ‘‘(I) eligible for medical assistance 

9 under a State plan under title XIX; or 

10 ‘‘(II) receiving aid or assistance under 

11 any plan of the territory approved under 

12 title I, X, XIV, or XVI.’’. 

13 Subtitle B—Part B 

14 SEC. 211. APPLICATION OF PART B DEEMED ENROLLMENT 

15 PROCESS TO RESIDENTS OF PUERTO RICO; 

16 SPECIAL ENROLLMENT PERIOD AND LIMIT 

17 ON LATE ENROLLMENT PENALTIES. 

18 (a) APPLICATION OF PART B DEEMED ENROLLMENT

19 PROCESS TO RESIDENTS OF PUERTO RICO.—Section 

20 1837(f)(3) of the Social Security Act (42 U.S.C. 

21 1395p(f)(3)) is amended by striking ‘‘, exclusive of Puerto 

22 Rico’’. 

23 (b) EFFECTIVE DATE.—The amendment made by 

24 subsection (a) shall apply to individuals whose initial en25 rollment period under section 1837(d) of the Social SecuVerDate Sep 11 2014 01:17 Oct 28, 2017 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2026.IS S2026

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1 rity Act begins on or after the first day of the effective 

2 month, specified by the Secretary of Health and Human 

3 Services under section 1839(j)(1)(C) of such Act, as added 

4 by subsection (c)(2). 

5 (c) TRANSITION PROVIDING SPECIAL ENROLLMENT

6 PERIOD AND LIMIT ON LATE ENROLLMENT PENALTIES

7 FOR CERTAIN MEDICARE BENEFICIARIES.—Section 1839 

8 of the Social Security Act (42 U.S.C. 1395r) is amend9 ed— 

10 (1) in the first sentence of subsection (b), by in11 serting ‘‘subject to section 1839(j)(2),’’ after ‘‘sub12 section (i)(4) or (l) of section 1837,’’; and 

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘(j) SPECIAL RULES FOR CERTAIN RESIDENTS OF

16 PUERTO RICO.— 

17 ‘‘(1) SPECIAL ENROLLMENT PERIOD, COVERAGE

18 PERIOD FOR RESIDENTS WHO ARE ELIGIBLE BUT

19 NOT ENROLLED.— 

20 ‘‘(A) IN GENERAL.—In the case of a tran21 sition individual (as defined in paragraph (3)) 

22 who is not enrolled under this part as of the 

23 day before the first day of the effective month 

24 (as defined in subparagraph (C)), the Secretary 

25 shall provide for a special enrollment period 


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1 under section 1837 of 7 months beginning with 

2 such effective month during which the indi3 vidual may be enrolled under this part. 

4 ‘‘(B) COVERAGE PERIOD.—In the case of 

5 such an individual who enrolls during such spe6 cial enrollment period, the coverage period 

7 under section 1838 shall begin on the first day 

8 of the second month after the month in which 

9 the individual enrolls. 

10 ‘‘(C) EFFECTIVE MONTH DEFINED.—In 

11 this section, the term ‘effective month’ means a 

12 month, not earlier than October 2017 and not 

13 later than January 2018, specified by the Sec14 retary. 

15 ‘‘(2) REDUCTION IN LATE ENROLLMENT PEN16 ALTIES FOR CURRENT ENROLLEES AND INDIVID17 UALS ENROLLING DURING TRANSITION.— 

18 ‘‘(A) IN GENERAL.—In the case of a tran19 sition individual who is enrolled under this part 

20 as of the day before the first day of the effec21 tive month or who enrolls under this part on or 

22 after the date of the enactment of this sub23 section but before the end of the special enroll24 ment period under paragraph (1)(A), the 

25 amount of the late enrollment penalty imposed 


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1 under section 1839(b) shall be recalculated by 

2 reducing the penalty to 15 percent of the pen3 alty otherwise established. 

4 ‘‘(B) APPLICATION.—Subparagraph (A) 

5 shall be applied in the case of a transition indi6 vidual who— 

7 ‘‘(i) is enrolled under this part as of 

8 the month before the effective month, for 

9 premiums for months beginning with such 

10 effective month; or 

11 ‘‘(ii) enrolls under this part on or 

12 after the date of the enactment of this Act 

13 and before the end of the special enroll14 ment period under paragraph (1)(A), for 

15 premiums for months during the coverage 

16 period under this part which occur during 

17 or after the effective month. 

18 ‘‘(C) LOSS OF REDUCTION IF INDIVIDUAL

19 TERMINATES ENROLLMENT.—Subparagraph 

20 (A) shall not apply to a transition individual if 

21 the individual terminates enrollment under this 

22 part after the end of the special enrollment pe23 riod under paragraph (1). 

24 ‘‘(3) TRANSITION INDIVIDUAL DEFINED.—In 

25 this section, the term ‘transition individual’ means 


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1 an individual who resides in Puerto Rico and who 

2 would have been deemed enrolled under this part 

3 pursuant to section 1837(f) before the first day of 

4 the effective month but for the fact that the indi5 vidual was a resident of Puerto Rico, regardless of 

6 whether the individual is enrolled under this part as 

7 of such first day.’’. 

8 Subtitle C—Medicare Advantage 

9 (Part C) 

10 SEC. 221. ADJUSTMENT IN BENCHMARK FOR LOW BASE 

11 PAYMENT COUNTIES IN PUERTO RICO. 

12 Section 1853(n) of the Social Security Act (42 U.S.C. 

13 1395w–23(n)) is amended— 

14 (1) in paragraph (1), by striking ‘‘and (5)’’ and 

15 inserting ‘‘, (5), and (6)’’; 

16 (2) in paragraph (4), by striking ‘‘In no case’’ 

17 and inserting ‘‘Subject to paragraph (6), in no 

18 case’’; and 

19 (3) by adding at the end the following new 

20 paragraph: 

21 ‘‘(6) SPECIAL RULES FOR BLENDED BENCH22 MARK AMOUNT FOR TERRITORIES.— 

23 ‘‘(A) IN GENERAL.—Subject to paragraph 

24 (2), the blended benchmark amount for an area 

25 in a territory for a year (beginning with 2018) 


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1 shall not be less than 80 percent of the national 

2 average of the base payment amounts specified 

3 in subparagraph (2)(E) for such year for areas 

4 within the 50 States and the District of Colum5 bia. 

6 ‘‘(B) LIMITATION.—In no case shall the 

7 blended benchmark amount for an area in a 

8 territory for a year under subparagraph (A) ex9 ceed the lowest blended benchmark amount for 

10 any area within the 50 States and the District 

11 of Columbia for such year.’’. 

12 Subtitle D—Part D 

13 SEC. 231. ELIMINATING EXCLUSION OF PART D ELIGIBLE 

14 INDIVIDUALS RESIDING IN TERRITORIES 

15 FROM ELIGIBILITY FOR PREMIUM AND COST16 SHARING SUBSIDIES. 

17 (a) IN GENERAL.—Section 1860D–14(a)(3) of the 

18 Social Security Act (42 U.S.C. 1395w–114(a)(3)) is 

19 amended— 

20 (1) in subparagraph (A), in the matter pre21 ceding clause (i), by striking ‘‘subject to subpara22 graph (F),’’; 

23 (2) in subparagraph (B)(v), in the matter pre24 ceding subclause (I), by striking ‘‘Subject to subVerDate Sep 11 2014 01:17 Oct 28, 2017 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S2026.IS S2026

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1 paragraph (F), the Secretary’’ and inserting ‘‘The 

2 Secretary’’; 

3 (3) in subparagraph (C), by adding at the end 

4 the following new sentence: ‘‘In the case of an indi5 vidual who is not a resident of the 50 States or the 

6 District of Columbia, the poverty line (as such term 

7 is defined in clause (ii)) that shall apply to such in8 dividual shall be the poverty line for the 48 contig9 uous States and the District of Columbia.’’; and 

10 (4) by striking subparagraph (F). 

11 (b) APPLICATION OF MEDICAID PROVISIONS.—Sec12 tion 1935 of the Social Security Act (42 U.S.C. 1396u– 

13 5) is amended— 

14 (1) in subsection (a), by striking ‘‘subject to 

15 subsection (e)’’ in the matter preceding paragraph 

16 (1); and 

17 (2) by striking subsection (e). 

18 (c) CONFORMING AMENDMENT.—Section 1108(f) of 

19 the Social Security Act (42 U.S.C. 1308(f)) is amended 

20 by striking ‘‘and section 1935(e)(1)(B)’’ in the matter pre21 ceding clause (i). 

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

23 this section shall take effect on January 1, 2018. 


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1 SEC. 232. REPORT ON TREATMENT OF TERRITORIES 

2 UNDER MEDICARE PART D. 

3 Paragraph (4) of section 1935(e) of the Social Secu4 rity Act (42 U.S.C. 1396u–5(e)) is amended to read as 

5 follows: 

6 ‘‘(4) REPORT ON APPLICATION OF SUB7 SECTION.— 

8 ‘‘(A) IN GENERAL.—Not later than May 1, 

9 2018, the Secretary shall submit to Congress a 

10 report on the application of this subsection dur11 ing the period beginning with fiscal year 2006 

12 and ending with December 31, 2017. 

13 ‘‘(B) INFORMATION TO BE INCLUDED IN

14 REPORT.—Such report shall include— 

15 ‘‘(i) program guidance issued by the 

16 Secretary to implement this subsection; 

17 ‘‘(ii) for each of Puerto Rico, the Vir18 gin Islands of the United States, Guam, 

19 the Northern Mariana Islands, and Amer20 ican Samoa, information on the increased 

21 amount under paragraph (3) and how the 

22 territory has applied such amount, includ23 ing the territory’s program design, expend24 itures, and number of individuals (and 

25 dual-eligible individuals) assisted; and 


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1 ‘‘(iii) a description of the differences 

2 between how such territories are treated 

3 under part D of title XVIII and under this 

4 title compared with the treatment of the 

5 50 States and the District of Columbia 

6 under such part and this title for different 

7 fiscal years within the period covered 

8 under the report. 

9 ‘‘(C) RECOMMENDATIONS.—Such report 

10 shall include recommendations for improving 

11 prescription drug coverage for low-income indi12 viduals in each territory identified in subpara13 graph (B)(ii), including recommendations re14 garding each of the following alternative ap15 proaches: 

16 ‘‘(i) Adjusting the aggregate amount 

17 specified in paragraph (3)(B). 

18 ‘‘(ii) Allowing residents of the terri19 tories to be subsidy eligible individuals 

20 under section 1860D–14, notwithstanding 

21 subsection (a)(3)(F) of such section, or 

22 providing substantially equivalent low-in23 come prescription drug subsidies to such 

24 residents.’’. 


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1 TITLE III—MISCELLANEOUS 

2 SEC. 301. REPORT ON EXCLUSION OF TERRITORIES FROM 

3 EXCHANGES. 

4 (a) IN GENERAL.—Not later than February 1, 2019, 

5 the Secretary of Health and Human Services shall submit 

6 to Congress a report that details the adverse impacts in 

7 each territory from the practical exclusion of the terri8 tories from the provisions of part II of subtitle D of title 

9 I of the Patient Protection and Affordable Care Act inso10 far as such provisions provide for the establishment of an 

11 American Health Benefit Exchange or the administration 

12 of a federally facilitated Exchange in each State and in 

13 the District of Columbia for the purpose of making health 

14 insurance more affordable and accessible for individuals 

15 and small businesses. 

16 (b) INFORMATION IN REPORT.—The report shall in17 clude information on the following: 

18 (1) An estimate of the total number of unin19 sured and underinsured individuals residing in each 

20 territory with respect to health insurance coverage. 

21 (2) A description of the number of health insur22 ance issuers in each territory and the health insur23 ance plans these issuers offer. 

24 (3) An estimate of the number of individuals re25 siding in each territory who are denied premium and 


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1 cost-sharing assistance that would otherwise be 

2 available to them for obtaining health insurance cov3 erage through an Exchange if they resided in one of 

4 the 50 States or in the District of Columbia. 

5 (4) An estimate of the amount of Federal as6 sistance described in paragraph (3) that is not being 

7 made available to residents of each territory. 

8 (5) An estimate of the number of small employ9 ers in each territory that would be eligible to pur10 chase health insurance coverage through a Small 

11 Business Health Options Program (SHOP) Market12 place that would operate as part of an Exchange if 

13 the employers were in one of the 50 States or in the 

14 District of Columbia. 

15 SEC. 302. MEDICAID AND CHIP TERRITORY TRANSPARENCY 

16 AND INFORMATION. 

17 (a) PUBLICATION OF INFORMATION ON FEDERAL

18 EXPENDITURES UNDER MEDICAID AND CHIP IN THE

19 TERRITORIES.—Not later than 180 days after the date 

20 of enactment of this Act, the Secretary of Health and 

21 Human Services shall publish, and periodically update, on 

22 the Internet site of the Centers for Medicare & Medicaid 

23 Services information on Medicaid and CHIP carried out 

24 in the territories of the United States. Such information 

25 shall include, with respect to each such territory— 


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1 (1) the income levels established by the terri2 tory for purposes of eligibility of an individual to re3 ceive medical assistance under Medicaid or child 

4 health assistance under CHIP; 

5 (2) the number of individuals enrolled in Med6 icaid and CHIP in such territory; 

7 (3) any State plan amendments in effect to 

8 carry out Medicaid or CHIP in such territory; 

9 (4) any waiver of the requirements of title XIX 

10 or XXI of the Social Security Act (42 U.S.C. 1396 

11 et seq., 1397aa et seq.) issued by the Secretary to 

12 carry out Medicaid or CHIP in the territory, includ13 ing a waiver under section 1115 of the Social Secu14 rity Act (42 U.S.C. 1315), any application for such 

15 a waiver, and any documentation related to such ap16 plication (including correspondence); 

17 (5) the amount of the Federal and non-Federal 

18 share of expenditures under Medicaid and CHIP in 

19 such territory; 

20 (6) the systems in place for the furnishing of 

21 health care items and services under Medicaid and 

22 CHIP in such territory; 

23 (7) the design of CHIP in such territory; and 

24 (8) other information regarding the carrying 

25 out of Medicaid and CHIP in the territory that is 


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1 published on such Internet site with respect to car2 rying out Medicaid and CHIP in each of the 50 

3 States and the District of Columbia. 

4 (b) DEFINITIONS.—In this section: 

5 (1) CHIP.—The term ‘‘CHIP’’ means the 

6 State Children’s Health Insurance Program estab7 lished under title XXI of the Social Security Act (42 

8 U.S.C. 1397aa et seq.). 

9 (2) MEDICAID.—The term ‘‘Medicaid’’ means 

10 the Medicaid program established under title XIX of 

11 the Social Security Act (42 U.S.C. 1396 et seq.). 

12 (3) TERRITORY OF THE UNITED STATES.—The 

13 term ‘‘territory of the United States’’ means Puerto 

14 Rico, the Virgin Islands of the United States, Guam, 

15 the Northern Mariana Islands, and American 

16 Samoa. 

Æ 


lotter on DSKBCFDHB2PROD with BILLS