I 

111TH CONGRESS 

1ST SESSION H. R. 4260 

To provide adjusted Federal medical assistance percentage rates during a 

transitional assistance period. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 10, 2009 

Mr. GENE GREEN of Texas (for himself, Ms. DEGETTE, Ms. BALDWIN, and 

Mr. ENGEL) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To provide adjusted Federal medical assistance percentage 

rates during a transitional assistance period. 

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 ‘‘Transitional Federal 

5 Medical Assistance Percentage Act’’. 

6 SEC. 2. EXTENSION OF ARRA INCREASE IN FMAP. 

7 Section 5001 of ARRA is amended— 


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1 (1) in subsection (a)(3), by striking ‘‘first cal2 endar quarter’’ and inserting ‘‘first 3 calendar quar3 ters’’; 

4 (2) in subsection (b)(2), by inserting before the 

5 period at the end the following: ‘‘and such para6 graph shall not apply to calendar quarters beginning 

7 on or after October 1, 2010’’; 

8 (3) in subsection (d), by inserting ‘‘ending be9 fore October 1, 2010’’ after ‘‘entire fiscal years’’ and 

10 after ‘‘with respect to fiscal years’’; 

11 (4) in subsection (g)(1), by striking ‘‘September 

12 30, 2011’’ and inserting ‘‘December 31, 2011’’; and 

13 (5) in subsection (h)(3), by striking ‘‘December 

14 31, 2010’’ and inserting ‘‘June 30, 2011’’. 

15 SEC. 3. ARRA TRANSITIONAL ASSISTANCE PERIOD. 

16 For each fiscal quarter occurring during the period 

17 beginning on July 1, 2011, and ending on December 31, 

18 2013 (referred to in this Act as the ‘‘ARRA transitional 

19 assistance period’’), a State’s FMAP shall be equal to the 

20 sum of— 

21 (1) the adjusted base FMAP (as determined 

22 under section 4(a)(1)); 

23 (2) the general FMAP adjustment (as deter24 mined under section 4(a)(2)); and 


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1 (3) the unemployment FMAP adjustment (as 

2 determined under section 4(a)(3)). 

3 SEC. 4. ADJUSTMENTS TO FEDERAL MEDICAL ASSISTANCE 

4 PERCENTAGE. 

5 (a) DETERMINATION OF ADJUSTED FMAP.— 

6 (1) ADJUSTED BASE FMAP.— 

7 (A) IN GENERAL.—Subject to subpara8 graph (B), the adjusted base FMAP is deter9 mined as follows: 

10 (i) For the fourth quarter of fiscal 

11 year 2011, the FMAP that would have ap12 plied to the State under section 5001(a) of 

13 ARRA (assuming that such section ap14 plied) for such fiscal quarter minus 2 per15 centage points. 

16 (ii) For any subsequent fiscal quarter 

17 occurring during the ARRA transitional 

18 assistance period, the FMAP as deter19 mined under this paragraph for the pre20 ceding fiscal quarter minus 2 percentage 

21 points. 

22 (B) ELIMINATION OF NEGATIVE ADJUST23 MENT.—If the adjusted base FMAP applicable 

24 to a State under this paragraph for any fiscal 

25 quarter occurring during the ARRA transitional 


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1 assistance period would be less than the FMAP 

2 determined for the State for such quarter with3 out regard to this paragraph, this paragraph 

4 shall not apply to such State. 

5 (2) GENERAL FMAP ADJUSTMENT.—The gen6 eral FMAP adjustment shall be equal to the fol7 lowing: 

8 (A) For the fourth quarter of fiscal year 

9 2011, 5.7 percentage points. 

10 (B) For the first quarter of fiscal year 

11 2012, 4.95 percentage points. 

12 (C) For the second quarter of fiscal year 

13 2012, 3.95 percentage points. 

14 (D) For the third quarter of fiscal year 

15 2012, 2.7 percentage points. 

16 (E) For the fourth quarter of fiscal year 

17 2012, 1.2 percentage points. 

18 (F) For any subsequent fiscal quarter oc19 curring during the ARRA transitional assist20 ance period, 0.2 percentage points. 

21 (3) UNEMPLOYMENT FMAP ADJUSTMENT.— 

22 (A) IN GENERAL.—Subject to subpara23 graphs (C) and (D), the unemployment FMAP 

24 adjustment shall be equal to the increase in the 

25 State’s FMAP that would have applied to the 


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1 State under section 5001(c) of ARRA (assum2 ing that such section applied) for such fiscal 

3 quarter minus the applicable reduction amount 

4 (as described under subparagraph (B)). 

5 (B) APPLICABLE REDUCTION AMOUNT.— 

6 For purposes of subparagraph (A), the applica7 ble reduction amount shall be equal to the fol8 lowing: 

9 (i) For the fourth fiscal quarter of fis10 cal year 2011, 0.20 percentage points. 

11 (ii) For any subsequent fiscal quarter 

12 occurring during the ARRA transitional 

13 assistance period, the sum of— 

14 (I) the applicable reduction 

15 amount for the preceding fiscal quar16 ter; and 

17 (II) 0.05 percentage points. 

18 (C) ELIMINATION OF NEGATIVE ADJUST19 MENT.—If the unemployment FMAP adjust20 ment applicable to a State under this paragraph 

21 for any fiscal quarter during the ARRA transi22 tional assistance period would be less than zero, 

23 this paragraph shall not apply to such State. 

24 (D) SPECIAL RULE.— 


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1 (i) IN GENERAL.—For purposes of 

2 subparagraph (A), with respect to the com3 putation of the state unemployment in4 crease percentage (as described under sec5 tion 5001(c)(4) of ARRA) for the last 2 

6 fiscal quarters of the ARRA transitional 

7 assistance period, the most recent previous 

8 3-consecutive-month period (as described 

9 under section 5001(c)(4)(A)(i) of ARRA) 

10 shall be the 3-consecutive-month period be11 ginning with December 2012, or, if it re12 sults in a higher applicable percent under 

13 section 5001(c)(3) of ARRA, the 3-con14 secutive-month period beginning with Jan15 uary 2013. 

16 (ii) REPEAL OF SPECIAL RULE UNDER

17 ARRA FOR LAST 2 CALENDAR QUARTERS

18 OF THE RECESSION ADJUSTMENT PE19 RIOD.—Section 5001(c)(4) of ARRA is 

20 amended by striking subparagraph (C) and 

21 inserting the following: 

22 ‘‘(C) SPECIAL RULE.—With respect to the 

23 first 2 calendar quarters of the recession ad24 justment period, the most recent previous 3- 

25 consecutive-month period described in subparaVerDate Nov 24 2008 23:54 Dec 11, 2009 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4260.IH H4260

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1 graph (A)(i) shall be the 3-consecutive-month 

2 period beginning with October 2008.’’. 

3 (b) SCOPE OF APPLICATION.—The adjustments in 

4 the FMAP for a State under this section shall apply for 

5 purposes of title XIX of the Social Security Act and shall 

6 not apply with respect to— 

7 (1) disproportionate share hospital payments 

8 described in section 1923 of such Act (42 U.S.C. 

9 1396r–4); 

10 (2) payments under title IV of such Act (42 

11 U.S.C. 601 et seq.) (except that the increases under 

12 paragraphs (1) and (2) of subsection (a) shall apply 

13 to payments under part E of title IV of such Act (42 

14 U.S.C. 670 et seq.) and, for purposes of the applica15 tion of this section to the District of Columbia, pay16 ments under such part shall be deemed to be made 

17 on the basis of the FMAP applied with respect to 

18 such District for purposes of title XIX and as in19 creased under subsection (a)(2)); 

20 (3) any payments under title XXI of such Act 

21 (42 U.S.C. 1397aa et seq.); 

22 (4) any payments under title XIX of such Act 

23 that are based on the enhanced FMAP described in 

24 section 2105(b) of such Act (42 U.S.C. 1397ee(b)); 

25 or 


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1 (5) any payments under title XIX of such Act 

2 that are attributable to expenditures for medical as3 sistance provided to individuals made eligible under 

4 a State plan under title XIX of the Social Security 

5 Act (including under any waiver under such title or 

6 under section 1115 of such Act (42 U.S.C. 1315)) 

7 because of income standards (expressed as a per8 centage of the poverty line) for eligibility for medical 

9 assistance that are higher than the income stand10 ards (as so expressed) for such eligibility as in effect 

11 on July 1, 2008, (including as such standards were 

12 proposed to be in effect under a State law enacted 

13 but not effective as of such date or a State plan 

14 amendment or waiver request under title XIX of 

15 such Act that was pending approval on such date). 

16 (c) STATE INELIGIBILITY; LIMITATION; SPECIAL

17 RULES.— 

18 (1) MAINTENANCE OF ELIGIBILITY REQUIRE19 MENTS.— 

20 (A) IN GENERAL.—Subject to subpara21 graph (B) and (C), a State is not eligible for 

22 an increase in its FMAP under subsection (a) 

23 if eligibility standards, methodologies, or proce24 dures under its State plan under title XIX of 

25 the Social Security Act (including any waiver 


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1 under such title or under section 1115 of such 

2 Act (42 U.S.C. 1315)) are more restrictive than 

3 the eligibility standards, methodologies, or pro4 cedures, respectively, under such plan (or waiv5 er) as in effect on July 1, 2008. 

6 (B) STATE REINSTATEMENT OF ELIGI7 BILITY PERMITTED.—Subject to subparagraph 

8 (C), a State that has restricted eligibility stand9 ards, methodologies, or procedures under its 

10 State plan under title XIX of the Social Secu11 rity Act (including any waiver under such title 

12 or under section 1115 of such Act (42 U.S.C. 

13 1315)) after July 1, 2008, is no longer ineli14 gible under subparagraph (A) beginning with 

15 the first calendar quarter in which the State 

16 has reinstated eligibility standards, methodolo17 gies, or procedures that are no more restrictive 

18 than the eligibility standards, methodologies, or 

19 procedures, respectively, under such plan (or 

20 waiver) as in effect on July 1, 2008. 

21 (C) SPECIAL RULES.—A State shall not be 

22 ineligible under subparagraph (A)— 

23 (i) for the fiscal quarters before Octo24 ber 1, 2011, on the basis of a restriction 

25 that was applied after July 1, 2008, and 


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1 before the date of the enactment of this 

2 Act, if the State prior to October 1, 2011, 

3 has reinstated eligibility standards, meth4 odologies, or procedures that are no more 

5 restrictive than the eligibility standards, 

6 methodologies, or procedures, respectively, 

7 under such plan (or waiver) as in effect on 

8 July 1, 2008; or 

9 (ii) on the basis of a restriction that 

10 was directed to be made under State law 

11 as in effect on July 1, 2008, and would 

12 have been in effect as of such date, but for 

13 a delay in the effective date of a waiver 

14 under section 1115 of such Act with re15 spect to such restriction. 

16 (2) COMPLIANCE WITH PROMPT PAY REQUIRE17 MENTS.— 

18 (A) APPLICATION TO PRACTITIONERS.— 

19 (i) IN GENERAL.—Subject to the suc20 ceeding provisions of this subparagraph, no 

21 State shall be eligible for an increased 

22 FMAP rate as provided under this section 

23 for any claim received by a State from a 

24 practitioner subject to the terms of section 

25 1902(a)(37)(A) of the Social Security Act 


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1 (42 U.S.C. 1396a(a)(37)(A)) for such days 

2 during any period in which that State has 

3 failed to pay claims in accordance with 

4 such section as applied under title XIX of 

5 such Act. 

6 (ii) REPORTING REQUIREMENT.— 

7 Each State shall report to the Secretary, 

8 on a quarterly basis, its compliance with 

9 the requirements of clause (i) as such re10 quirements pertain to claims made for cov11 ered services during each month of the 

12 preceding quarter. 

13 (iii) WAIVER AUTHORITY.—The Sec14 retary may waive the application of clause 

15 (i) to a State, or the reporting requirement 

16 imposed under clause (ii), during any pe17 riod in which there are exigent cir18 cumstances, including natural disasters, 

19 that prevent the timely processing of 

20 claims or the submission of such a report. 

21 (iv) APPLICATION TO CLAIMS.— 

22 Clauses (i) and (ii) shall only apply to 

23 claims made for covered services after the 

24 date of enactment of this Act. 


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1 (B) APPLICATION TO NURSING FACILITIES

2 AND HOSPITALS.—The provisions of subpara3 graph (A) shall apply with respect to a nursing 

4 facility or hospital, insofar as it is paid under 

5 title XIX of the Social Security Act on the basis 

6 of submission of claims, in the same or similar 

7 manner (but within the same timeframe) as 

8 such provisions apply to practitioners described 

9 in such subparagraph. 

10 (3) STATE’S APPLICATION TOWARD RAINY DAY

11 FUND.—A State is not eligible for an increase in its 

12 FMAP under paragraphs (2) or (3) of subsection (a) 

13 if any amounts attributable (directly or indirectly) to 

14 such increase are deposited or credited into any re15 serve or rainy day fund of the State. 

16 (4) NO WAIVER AUTHORITY.—Except as pro17 vided in paragraph (2)(A)(iii), the Secretary may 

18 not waive the application of this subsection or sub19 section (d) under section 1115 of the Social Security 

20 Act or otherwise. 

21 (5) LIMITATION OF FMAP TO 100 PERCENT.—In 

22 no case shall an increase in FMAP under this sec23 tion result in an FMAP that exceeds 100 percent. 

24 (d) REQUIREMENTS.— 


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1 (1) STATE REPORTS.—Each State that is paid 

2 additional Federal funds as a result of this section 

3 shall, not later than September 30, 2014, submit a 

4 report to the Secretary, in such form and such man5 ner as the Secretary shall determine, regarding how 

6 the additional Federal funds were expended. 

7 (2) ADDITIONAL REQUIREMENT FOR CERTAIN

8 STATES.—In the case of a State that requires polit9 ical subdivisions within the State to contribute to10 ward the non-Federal share of expenditures under 

11 the State Medicaid plan required under section 

12 1902(a)(2) of the Social Security Act (42 U.S.C. 

13 1396a(a)(2)), the State is not eligible for an in14 crease in its FMAP under paragraphs (2) or (3) of 

15 subsection (a) if it requires that such political sub16 divisions pay for quarters during the ARRA transi17 tional assistance period a greater percentage of the 

18 non-Federal share of such expenditures, or a greater 

19 percentage of the non-Federal share of payments 

20 under section 1923, than the respective percentage 

21 that would have been required by the State under 

22 such plan on September 30, 2008, prior to applica23 tion of this section. 

24 (e) DEFINITIONS.—In this Act, except as otherwise 

25 provided: 


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1 (1) ARRA.—The term ‘‘ARRA’’ means the 

2 American Recovery and Reinvestment Act of 2009 

3 (Public Law 111–5; 123 Stat. 140). 

4 (2) FMAP.—The term ‘‘FMAP’ ’’ means the 

5 Federal medical assistance percentage, as defined in 

6 section 1905(b) of the Social Security Act (42 

7 U.S.C. 1396d(b)), as determined without regard to 

8 this section except as otherwise specified. 

9 (3) POVERTY LINE.—The term ‘‘poverty line’’ 

10 has the meaning given such term in section 673(2) 

11 of the Community Services Block Grant Act (42 

12 U.S.C. 9902(2)), including any revision required by 

13 such section. 

14 (4) SECRETARY.—The term ‘‘Secretary’’ means 

15 the Secretary of Health and Human Services. 

16 (5) STATE.—The term ‘‘State’’ has the mean17 ing given such term in section 1101(a)(1) of the So18 cial Security Act (42 U.S.C. 1301(a)(1)) for pur19 poses of title XIX of the Social Security Act (42 

20 U.S.C. 1396 et seq.). 

21 (f) SUNSET.—This section shall not apply to items 

22 and services furnished after the end of the ARRA transi23 tional assistance period. 

Æ 


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