I 

118TH CONGRESS 

1ST SESSION H. R. 6029 

To provide Medicaid assistance to individuals and families affected by a 

disaster or emergency, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 24, 2023 

Mr. PANETTA (for himself, Ms. TOKUDA, Ms. CROCKETT, Ms. BLUNT ROCHESTER, Ms. NORTON, Ms. MOORE of Wisconsin, and Mr. SOTO) introduced the following bill 

OCTOBER 25, 2023 

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 Medicaid assistance to individuals and families 

affected by a disaster or emergency, 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 ‘‘Disaster Relief Med5 icaid Act’’. 


ddrumheller on DSK120RN23PROD with BILLS
2 

•HR 6029 IH

1 SEC. 2. MEDICAID RELIEF FOR DISASTER SURVIVORS. 

2 Title XIX of the Social Security Act (42 U.S.C. 1396 

3 et seq.) is amended— 

4 (1) in section 1902(a)— 

5 (A) in paragraph (86), by striking ‘‘; and’’ 

6 and inserting a semicolon; 

7 (B) in paragraph (87), by striking the pe8 riod at the end and inserting ‘‘; and’’; and 

9 (C) by inserting after paragraph (87) the 

10 following new paragraph: 

11 ‘‘(88) beginning January 1, 2025, provide for 

12 making medical assistance available to relief-eligible 

13 survivors of disasters during relief coverage periods 

14 in accordance with section 1948.’’; and 

15 (2) by adding at the end the following new sec16 tion: 

17 ‘‘SEC. 1948. DISASTER RELIEF MEDICAID FOR SURVIVORS 

18 OF MAJOR DISASTERS. 

19 ‘‘(a) IN GENERAL.—Notwithstanding any other pro20 vision of this title, a State plan shall provide medical as21 sistance to a relief-eligible survivor of a disaster in accord22 ance with this section. 

23 ‘‘(b) DEFINITIONS.—In this section: 

24 ‘‘(1) DISASTER.—The term ‘disaster’ means 

25 any of the following: 


ddrumheller on DSK120RN23PROD with BILLS
3 

•HR 6029 IH

1 ‘‘(A) A major disaster that is declared on 

2 or after January 1, 2025, by the President in 

3 accordance with section 401 of the Robert T. 

4 Stafford Disaster Relief and Emergency Assist5 ance Act (42 U.S.C. 5170) and which the 

6 President has determined warrants individual 

7 or public assistance from the Federal Govern8 ment under such Act. 

9 ‘‘(B) A national emergency declared by the 

10 President under the National Emergencies Act 

11 (50 U.S.C. 1601 et seq.). 

12 ‘‘(C) A public health emergency declared 

13 by the Secretary pursuant to section 319 of the 

14 Public Health Service Act (42 U.S.C. 247d). 

15 ‘‘(2) DIRECT IMPACT AREA.— 

16 ‘‘(A) IN GENERAL.—The term ‘direct im17 pact area’ means, with respect to a disaster, the 

18 geographic area in which the disaster exists. 

19 ‘‘(B) WEBSITE POSTING OF DIRECT IM20 PACT AREAS.—As soon as practicable after a 

21 disaster is declared (as described in subpara22 graph (A), (B), or (C) of paragraph (1), as ap23 plicable), the Secretary shall post on the 

24 websites of the Centers for Medicare & Med25 icaid Services and the Federal Emergency ManVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
4 

•HR 6029 IH

1 agement Agency a list of the areas identified as 

2 the direct impact areas of the disaster. 

3 ‘‘(3) HOME STATE.—The term ‘home State’ 

4 means, with respect to a survivor of a disaster, the 

5 State in which the survivor was a resident (as deter6 mined in accordance with section 435.403 of title 

7 42, Code of Federal Regulations (or any successor 

8 regulation)) on the date on which the disaster is de9 clared (as described in subparagraph (A), (B), or 

10 (C) of paragraph (1), as applicable). 

11 ‘‘(4) RELIEF COVERAGE PERIOD.—The term 

12 ‘relief coverage period’ means, with respect to a dis13 aster, the period that begins on the date the disaster 

14 is declared (as described in subparagraph (A), (B), 

15 or (C) of paragraph (1), as applicable) and ends on 

16 the day that is 2 years after such date. 

17 ‘‘(5) RELIEF-ELIGIBLE SURVIVOR.— 

18 ‘‘(A) IN GENERAL.—Subject to subpara19 graph (C), the term ‘relief-eligible survivor’ 

20 means an individual who is a survivor of a dis21 aster whose family income does not exceed the 

22 higher of— 

23 ‘‘(i) 133 percent (or, in the case of a 

24 survivor who is a pregnant individual, a 

25 child, or a recipient of benefits under title 


ddrumheller on DSK120RN23PROD with BILLS
5 

•HR 6029 IH

1 II on the basis of a disability, 200 percent) 

2 of the poverty line; or 

3 ‘‘(ii) the income eligibility standard 

4 that would otherwise apply to the survivor 

5 under the State plan of the survivor’s 

6 home State (or a waiver of such plan). 

7 ‘‘(B) DISREGARD OF UNEMPLOYMENT IN8 COME AND FEMA INDIVIDUAL ASSISTANCE

9 GRANTS.—For purposes of this section, and 

10 notwithstanding section 1902(e)(14)(B), the in11 come of a survivor of a disaster shall not in12 clude— 

13 ‘‘(i) any amount received by the sur14 vivor during the relief coverage period of 

15 the disaster under a law of the United 

16 States or a State which is in the nature of 

17 unemployment compensation; or 

18 ‘‘(ii) any amount received during the 

19 relief coverage period of the disaster by the 

20 survivor (or the survivor’s household) as 

21 assistance under a program administered 

22 by the Federal Emergency Management 

23 Agency. 

24 ‘‘(C) LIMITATION TO RELIEF COVERAGE

25 PERIOD.— 


ddrumheller on DSK120RN23PROD with BILLS
6 

•HR 6029 IH

1 ‘‘(i) IN GENERAL.—Except as pro2 vided in clauses (ii) and (iii), for purposes 

3 of this section, an individual shall not be 

4 considered to be a relief-eligible survivor on 

5 the basis of the individual’s status as a 

6 survivor of a disaster after the end of the 

7 relief coverage period of the disaster. 

8 ‘‘(ii) CONTINUOUS ELIGIBILITY FOR

9 DISASTER RELIEF COVERAGE FOR PREG10 NANT AND POSTPARTUM INDIVIDUALS.—In 

11 the case of an individual who, while preg12 nant, receives medical assistance as a re13 lief-eligible survivor of a disaster under a 

14 State plan (or a waiver of such a plan) in 

15 accordance with this section, such indi16 vidual shall continue to be eligible for med17 ical assistance as a relief-eligible survivor 

18 through the end of the month in which the 

19 60-day period (beginning on the last day of 

20 the pregnancy) (or, if longer, the period of 

21 postpartum continuous eligibility that oth22 erwise applies to individuals who, while 

23 pregnant, are eligible for medical assist24 ance under the State plan or waiver) ends, 

25 without regard to whether the pregnancy 


ddrumheller on DSK120RN23PROD with BILLS
7 

•HR 6029 IH

1 ends before or after the end of the relief 

2 coverage period of the disaster. 

3 ‘‘(iii) CONTINUOUS ELIGIBILITY FOR

4 INDIVIDUALS WITH PENDING APPLICA5 TIONS.—If an individual who receives med6 ical assistance as a relief-eligible survivor 

7 of a disaster under a State plan (or a 

8 waiver of such a plan) in accordance with 

9 this section has an application pending for 

10 medical assistance under the State plan (or 

11 waiver) under this title or for child health 

12 assistance or pregnancy-related assistance 

13 under a State plan under title XXI (or a 

14 waiver of such a plan) on the date that the 

15 relief coverage period of the disaster ends, 

16 such individual shall continue to be eligible 

17 for medical assistance as a relief-eligible 

18 survivor through the earlier of— 

19 ‘‘(I) the end of the month in 

20 which the 60-day period (beginning on 

21 the last day of such relief coverage pe22 riod) ends; and 

23 ‘‘(II) the date on which the indi24 vidual’s application for medical assist25 ance, child health assistance, or pregVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
8 

•HR 6029 IH

1 nancy-related assistance (as applica2 ble) is approved or denied. 

3 ‘‘(6) SURVIVOR.— 

4 ‘‘(A) IN GENERAL.—The term ‘survivor’ 

5 means, with respect to a disaster, an individual 

6 who is described in subparagraph (B) or (C). 

7 ‘‘(B) RESIDENTS AND EVACUEES OF DI8 RECT IMPACT AREAS.—An individual described 

9 in this subparagraph is an individual who, on 

10 the date on which a disaster is declared (as de11 scribed in subparagraph (A), (B), or (C) of 

12 paragraph (1), as applicable), has a primary 

13 residence in the disaster’s direct impact area. 

14 ‘‘(C) INDIVIDUALS WHO LOST EMPLOY15 MENT.—An individual described in this sub16 paragraph is an individual— 

17 ‘‘(i) whose worksite was located in the 

18 disaster’s direct impact area; 

19 ‘‘(ii) who was employed by an em20 ployer that— 

21 ‘‘(I) conducted an active trade or 

22 business in such area on the date on 

23 which the disaster was declared (as so 

24 described); and 


ddrumheller on DSK120RN23PROD with BILLS
9 

•HR 6029 IH

1 ‘‘(II) was unable to operate such 

2 trade or business as a result of the 

3 disaster on any day during the disas4 ter’s relief coverage period; and 

5 ‘‘(iii) whose employment with such 

6 employer was terminated. 

7 ‘‘(D) TREATMENT OF HOMELESS PER8 SONS.—In the case of an individual who is 

9 homeless (as such term is defined in section 

10 103(a) of the McKinney-Vento Homeless As11 sistance Act (42 U.S.C. 11302(a))) on the date 

12 on which a disaster is declared (as so de13 scribed), the individual’s residency for purposes 

14 of subparagraph (B) shall be determined in ac15 cordance with section 435.403 of title 42, Code 

16 of Federal Regulations (or any successor regu17 lation). 

18 ‘‘(E) EFFECT OF CONCURRENT ELIGI19 BILITY FOR MEDICAID OR CHIP.—An individ20 ual’s eligibility for medical assistance under a 

21 State plan (or waiver of such plan) (or for child 

22 health assistance or pregnancy-related assist23 ance under a State plan under title XXI (or a 

24 waiver of such a plan)) on a basis other than 

25 under this section shall not prevent the indiVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
10 

•HR 6029 IH

1 vidual from being treated as a survivor under 

2 this section, and the rights afforded to an indi3 vidual who is eligible for or enrolled under a 

4 State plan (or waiver) under either such title 

5 shall not be affected by the individual’s receipt 

6 of medical assistance as a relief-eligible survivor 

7 of a disaster in accordance with this section. 

8 ‘‘(c) ELIGIBILITY.— 

9 ‘‘(1) SIMPLIFIED APPLICATION.— 

10 ‘‘(A) IN GENERAL.—For purposes of deter11 mining eligibility for medical assistance under 

12 this section, each State may accept a simplified, 

13 streamlined application form (as developed by 

14 the Secretary in consultation with the National 

15 Association of State Medicaid Directors), which 

16 shall— 

17 ‘‘(i) require an applicant for medical 

18 assistance in accordance with this section 

19 as a survivor of a disaster to— 

20 ‘‘(I) provide the applicant’s mail21 ing address for the duration of the re22 lief coverage period of the disaster; 

23 and 


ddrumheller on DSK120RN23PROD with BILLS
11 

•HR 6029 IH

1 ‘‘(II) agree to update the infor2 mation described in subclause (I) if it 

3 changes during such period; 

4 ‘‘(ii) provide notice of the penalties for 

5 making a fraudulent application described 

6 in subsection (g); 

7 ‘‘(iii) require the applicant to assign 

8 to the State any rights of the applicant (or 

9 any other individual who is a relief-eligible 

10 survivor and on whose behalf the applicant 

11 has the legal authority to execute an as12 signment of such rights) as described and 

13 in accordance with the requirements of sec14 tion 1912; 

15 ‘‘(iv) require the applicant to list any 

16 health insurance coverage in which the ap17 plicant was enrolled immediately prior to 

18 submitting the application for medical as19 sistance under this section; and 

20 ‘‘(v) require the applicant to self-at21 test that the applicant— 

22 ‘‘(I) is a relief-eligible survivor of 

23 the disaster; and 

24 ‘‘(II) if applicable, requires home 

25 and community-based services. 


ddrumheller on DSK120RN23PROD with BILLS
12 

•HR 6029 IH

1 ‘‘(B) NO DOCUMENTATION REQUIRE2 MENT.— 

3 ‘‘(i) IN GENERAL.—A State shall not 

4 require an applicant for medical assistance 

5 as a survivor of a disaster under this sec6 tion to provide any documentation or other 

7 evidence— 

8 ‘‘(I) of the applicant’s status as a 

9 relief-eligible survivor; and 

10 ‘‘(II) if applicable, that the appli11 cant requires home and community12 based services. 

13 ‘‘(ii) USE OF AVAILABLE ELECTRONIC

14 DATA SOURCES.—In making determina15 tions with respect to the status of an appli16 cant for medical assistance as a survivor of 

17 a disaster under this section, or such an 

18 applicant’s need for home and community19 based services, a State may use data relat20 ing to the applicant that is available to the 

21 State from electronic data sources. 

22 ‘‘(2) PRESUMPTIVE ELIGIBILITY FOR RELIEF23 ELIGIBLE SURVIVORS.— 

24 ‘‘(A) IN GENERAL.—A State shall provide 

25 for making medical assistance available to an 


ddrumheller on DSK120RN23PROD with BILLS
13 

•HR 6029 IH

1 individual as a relief-eligible survivor under this 

2 section during a presumptive eligibility period. 

3 ‘‘(B) PRESUMPTIVE ELIGIBILITY PERIOD

4 DEFINED.—For purposes of this paragraph— 

5 ‘‘(i) the term ‘presumptive eligibility 

6 period’ means, with respect to an indi7 vidual, the period that— 

8 ‘‘(I) begins with the date on 

9 which a qualified provider determines, 

10 on the basis of preliminary informa11 tion, that the individual satisfies the 

12 criteria for eligibility for medical as13 sistance as a relief-eligible survivor 

14 under this section; and 

15 ‘‘(II) ends with (and includes) 

16 the earlier of— 

17 ‘‘(aa) the day on which a de18 termination is made with respect 

19 to the eligibility of the individual 

20 for medical assistance as a relief21 eligible survivor under this sec22 tion; or 

23 ‘‘(bb) in the case of an indi24 vidual who does not file an appli25 cation by the last day of the 


ddrumheller on DSK120RN23PROD with BILLS
14 

•HR 6029 IH

1 month following the month dur2 ing which the provider makes the 

3 determination referred to in item 

4 (aa), such last day; and 

5 ‘‘(ii) the term ‘qualified provider’ has 

6 the meaning given such term in section 

7 1920. 

8 ‘‘(C) COORDINATION BETWEEN STATE

9 AGENCIES AND QUALIFIED PROVIDERS.— 

10 ‘‘(i) PROVISION OF FORMS AND IN11 FORMATION TO QUALIFIED PROVIDERS.— 

12 The State agency shall provide qualified 

13 providers with— 

14 ‘‘(I) such forms as are necessary 

15 for an individual to make application 

16 for medical assistance under the State 

17 plan as a relief-eligible survivor; and 

18 ‘‘(II) information on how to as19 sist individuals and their authorized 

20 representatives in completing and fil21 ing such forms. 

22 ‘‘(ii) PROVISION OF NOTICE OF DE23 TERMINATIONS TO STATE AGENCIES.—A 

24 qualified provider that determines under 

25 this subparagraph that an individual is eliVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
15 

•HR 6029 IH

1 gible for medical assistance under a State 

2 plan as a relief-eligible survivor under this 

3 section shall— 

4 ‘‘(I) notify the State agency of 

5 the determination within 5 working 

6 days after the date on which deter7 mination is made; and 

8 ‘‘(II) inform the individual at the 

9 time the determination is made that 

10 the individual is required to make ap11 plication for medical assistance under 

12 the State plan by not later than the 

13 last day of the month following the 

14 month during which the determination 

15 is made. 

16 ‘‘(D) APPLICATION REQUIREMENT.—An 

17 individual who is determined by a qualified pro18 vider to be presumptively eligible as a relief-eli19 gible survivor for medical assistance under a 

20 State plan shall make application for medical 

21 assistance under such plan by not later than 

22 the last day of the month following the month 

23 during which the determination is made, which 

24 application may be the streamlined application 

25 described in paragraph (1). 


ddrumheller on DSK120RN23PROD with BILLS
16 

•HR 6029 IH

1 ‘‘(E) TREATMENT AS MEDICAL ASSIST2 ANCE.—Notwithstanding any other provision of 

3 this title, items and services that are— 

4 ‘‘(i) furnished to an individual during 

5 a presumptive eligibility period under this 

6 paragraph by a provider that is eligible for 

7 payments under the State plan; and 

8 ‘‘(ii) included in the care and services 

9 covered by the State plan, 

10 shall be treated as medical assistance provided 

11 to a relief-eligible survivor of a disaster during 

12 the relief coverage period of the disaster under 

13 this section. 

14 ‘‘(3) CONTINUOUS ELIGIBILITY.— 

15 ‘‘(A) IN GENERAL.—Subject to subpara16 graph (B), an individual who is determined by 

17 a State to be a relief-eligible survivor of a dis18 aster shall remain eligible for medical assistance 

19 under the State plan (or a waiver of such plan) 

20 as such a survivor, without the need for any re21 determination of eligibility, for the duration of 

22 the relief coverage period of the disaster. 

23 ‘‘(B) EXCEPTIONS.—A State may termi24 nate the eligibility of an individual who is deter25 mined by a State to be a relief-eligible survivor 


ddrumheller on DSK120RN23PROD with BILLS
17 

•HR 6029 IH

1 of a disaster before the end of the relief cov2 erage period of the disaster if— 

3 ‘‘(i) the individual (or the individual’s 

4 authorized representative) requests a vol5 untary termination of eligibility; 

6 ‘‘(ii) the individual ceases to be a resi7 dent of the State; 

8 ‘‘(iii) the State determines that eligi9 bility was erroneously granted because of 

10 State error or fraud, abuse, or perjury at11 tributed to the individual (or the individ12 ual’s authorized representative); or 

13 ‘‘(iv) the individual dies. 

14 ‘‘(4) ISSUANCE OF DISASTER RELIEF MEDICAID

15 ELIGIBILITY CARD.—A State shall issue a disaster 

16 relief Medicaid eligibility card to each applicant who 

17 is determined to be a relief-eligible survivor of a dis18 aster and eligible for medical assistance under this 

19 section, which shall be valid for the duration of the 

20 relief coverage period of the disaster. 

21 ‘‘(5) VERIFICATION OF STATUS AS A RELIEF22 ELIGIBLE SURVIVOR.— 

23 ‘‘(A) IN GENERAL.—The State shall make 

24 a good faith effort to verify the status of an in25 dividual who is enrolled in the State plan (or a 


ddrumheller on DSK120RN23PROD with BILLS
18 

•HR 6029 IH

1 waiver of such plan) as a relief-eligible survivor 

2 of a disaster in accordance with this section. 

3 Such effort shall not delay the determination of 

4 the eligibility of the individual for medical as5 sistance under this section, and a State may en6 roll an individual in the State plan or waiver 

7 under this section pending such verification. 

8 ‘‘(B) EVIDENCE OF VERIFICATION.—A 

9 State may satisfy the verification requirement 

10 under subparagraph (A) with respect to an in11 dividual by showing that the State obtained in12 formation from the Social Security Administra13 tion, the Internal Revenue Service, or, if appli14 cable, the State Medicaid agency of the home 

15 State of the individual. 

16 ‘‘(6) DETERMINATION BY EXPRESS LANE AGEN17 CY.—Any determination or redetermination of eligi18 bility or verification of status made under this sec19 tion shall be made by an Express Lane agency (as 

20 defined in section 1902(e)(13)(F)). 

21 ‘‘(d) SCOPE OF COVERAGE.— 

22 ‘‘(1) IN GENERAL.—A State providing medical 

23 assistance to a relief-eligible survivor of a disaster in 

24 accordance with this section shall provide medical 

25 assistance that is at least equal in amount and scope 


ddrumheller on DSK120RN23PROD with BILLS
19 

•HR 6029 IH

1 to the medical assistance that would otherwise be 

2 made available to such survivor if the survivor were 

3 enrolled in the State plan (or waiver of such plan) 

4 as an individual described in clause (i) of section 

5 1902(a)(10)(A), except that, in the case of such a 

6 survivor whose home State is not the State providing 

7 medical assistance to the individual, the State shall 

8 also provide medical assistance for any item or serv9 ice for which medical assistance is available to indi10 viduals described in clause (i) of section 

11 1902(a)(10)(A) under the State plan (or waiver) of 

12 the survivor’s home State. 

13 ‘‘(2) PROVIDER PAYMENT RATES FOR HOME

14 STATE SERVICES.—In the case of medical assistance 

15 provided under this section by a State to a relief-eli16 gible survivor of a disaster whose home State is not 

17 the State providing such assistance for an item or 

18 service which is not otherwise available under the 

19 State plan (or waiver of such plan) but which is 

20 available under the State plan (or waiver) of the sur21 vivor’s home State, the State shall pay the provider 

22 of such item or service at least at the same rate that 

23 the home State would pay for the item or service if 

24 it were provided under the plan or waiver of the 

25 home State (or, if no such payment rate applies 


ddrumheller on DSK120RN23PROD with BILLS
20 

•HR 6029 IH

1 under the plan or waiver of the home State, the 

2 usual and customary prevailing rate for the item or 

3 service for the community in which it is provided). 

4 ‘‘(3) RETROACTIVE COVERAGE.— 

5 ‘‘(A) IN GENERAL.—Notwithstanding sec6 tion 1905(a), a State shall provide medical as7 sistance for items and services furnished in the 

8 State beginning with the first day of the relief 

9 coverage period of a disaster to any relief-eligi10 ble survivor of the disaster who submits an ap11 plication for such assistance before the deadline 

12 described in subparagraph (B). 

13 ‘‘(B) APPLICATION DEADLINE.—The dead14 line for a relief-eligible survivor of a disaster to 

15 submit an application for medical assistance in 

16 accordance with this section is the date that is 

17 90 days after the end of the disaster’s relief 

18 coverage period. 

19 ‘‘(4) CHILDREN BORN TO RELIEF-ELIGIBLE

20 SURVIVORS OF A DISASTER.—In the case of a child 

21 born to a relief-eligible survivor of a disaster who is 

22 provided medical assistance in accordance with this 

23 section during the relief coverage period of the dis24 aster, the child shall be treated as having been born 

25 to a pregnant individual eligible for medical assistVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
21 

•HR 6029 IH

1 ance under the State plan (or waiver of such plan) 

2 and shall be eligible for medical assistance under 

3 such plan (or waiver) in accordance with section 

4 1902(e)(4). Notwithstanding subsection (f), the Fed5 eral medical assistance percentage determined for a 

6 State and fiscal year under section 1905(b) shall 

7 apply to medical assistance provided during the year 

8 to a child under the State plan (or waiver) in ac9 cordance with the preceding sentence. 

10 ‘‘(5) OPTION TO PROVIDE EXTENDED MENTAL

11 HEALTH AND CARE COORDINATION BENEFITS.—A 

12 State may provide, without regard to any restric13 tions on amount, duration, scope, or comparability, 

14 or other restrictions under this title or the State 

15 plan or waiver of such plan (other than restrictions 

16 applicable to services provided in an institution for 

17 mental diseases), medical assistance to relief-eligible 

18 survivors of a disaster under this section for ex19 tended mental health and care coordination services, 

20 which may include the following: 

21 ‘‘(A) Screening, assessment, and diagnostic 

22 services (including specialized assessments for 

23 individuals with cognitive impairments). 

24 ‘‘(B) Coverage for a full range of mental 

25 health medications at the dosages and freVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
22 

•HR 6029 IH

1 quencies prescribed by health professionals for 

2 depression, post-traumatic stress disorder, and 

3 other mental disorders. 

4 ‘‘(C) Treatment of alcohol and substance 

5 abuse determined to result from circumstances 

6 related to the disaster. 

7 ‘‘(D) Psychotherapy, rehabilitation and 

8 other treatments administered by psychiatrists, 

9 psychologists, social workers, or other qualified 

10 mental or behavioral health professionals for 

11 conditions exacerbated by, or resulting from, 

12 the disaster. 

13 ‘‘(E) Peer support services related to the 

14 disaster. 

15 ‘‘(F) Mobile crisis services to assist with 

16 crises related to the disaster. 

17 ‘‘(G) Inpatient and outpatient mental 

18 health care. 

19 ‘‘(H) Family counseling for families where 

20 a member of the immediate family is a survivor 

21 of the disaster or a first responder to the dis22 aster or includes an individual who has died as 

23 a result of the disaster. 

24 ‘‘(I) In connection with the provision of 

25 health and long-term care services, arranging 


ddrumheller on DSK120RN23PROD with BILLS
23 

•HR 6029 IH

1 for, (and when necessary, enrollment in waiver 

2 programs or other specialized programs), and 

3 coordination related to, primary and specialty 

4 medical care, which may include personal care 

5 services, durable medical equipment and sup6 plies, assistive technology, and transportation. 

7 ‘‘(6) OPTION TO PROVIDE HOME AND COMMU8 NITY-BASED SERVICES.— 

9 ‘‘(A) IN GENERAL.—A State may provide 

10 medical assistance under this section for home 

11 and community-based services to a relief-eligible 

12 survivor of a disaster, including any survivor 

13 who is an individual described in subparagraph 

14 (B), who self-attests that the survivor imme15 diately requires such services, without regard to 

16 whether the survivor would require the level of 

17 care provided in a hospital, nursing facility, or 

18 intermediate care facility for the develop19 mentally disabled. 

20 ‘‘(B) INDIVIDUALS DESCRIBED.—Individ21 uals described in this subparagraph are relief22 eligible survivors of a disaster who— 

23 ‘‘(i) on any day during the week pre24 ceding the date on which the disaster is de25 clared (as described in subparagraph (A), 


ddrumheller on DSK120RN23PROD with BILLS
24 

•HR 6029 IH

1 (B), or (C) of subsection (b)(1), as applica2 ble)— 

3 ‘‘(I) had been receiving home and 

4 community-based services in a direct 

5 impact area under a waiver under sec6 tion 1115 or section 1915; 

7 ‘‘(II) had been receiving support 

8 services from a family caregiver who, 

9 as a result of the disaster, is no 

10 longer available to provide services; or 

11 ‘‘(III) had been receiving per12 sonal care, home health, or rehabilita13 tive services under a State plan under 

14 this title or under a waiver granted 

15 under section 1115 or 1915; or 

16 ‘‘(ii) are disabled (as determined in 

17 accordance with the State plan of the home 

18 State of the individual). 

19 ‘‘(C) WAIVER OF RESTRICTIONS.—With re20 spect to the provision of home and community21 based services under this paragraph, the Sec22 retary— 

23 ‘‘(i) shall waive any limitations on— 

24 ‘‘(I) the number of individuals 

25 who may receive home or communityVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
25 

•HR 6029 IH

1 based services under a waiver de2 scribed in subparagraph (B)(i)(I); 

3 ‘‘(II) budget neutrality require4 ments applicable to such waiver; and 

5 ‘‘(III) populations eligible for 

6 services under such waiver; and 

7 ‘‘(ii) may waive any other restriction 

8 applicable under such a waiver that would 

9 prevent a State from providing home and 

10 community-based services in accordance 

11 with this paragraph. 

12 ‘‘(e) STATE REPORTS.—Each State shall submit to 

13 the Secretary an annual report that includes— 

14 ‘‘(1) the number of survivors of a disaster who 

15 were determined by the State to be relief-eligible 

16 survivors of a disaster in the preceding year; and 

17 ‘‘(2) the number of relief-eligible survivors of a 

18 disaster who were determined to be eligible for, and 

19 enrolled in, the State plan (or waiver of such plan) 

20 or the State child health plan under title XXI (or 

21 waiver of such plan) other than under this section. 

22 ‘‘(f) 100 PERCENT FEDERAL MATCHING PAY23 MENTS.— 

24 ‘‘(1) IN GENERAL.—Notwithstanding section 

25 1905(b), the Federal medical assistance percentage 


ddrumheller on DSK120RN23PROD with BILLS
26 

•HR 6029 IH

1 shall be equal to 100 percent with respect to 

2 amounts expended by a State— 

3 ‘‘(A) for medical assistance provided in ac4 cordance with this section to relief-eligible sur5 vivors of a disaster during the relief coverage 

6 period of the disaster and, in the case of indi7 viduals described in clause (ii) or (iii) of sub8 section (b)(5)(C), during the applicable periods 

9 described in such clauses; and 

10 ‘‘(B) that are directly attributable to ad11 ministrative activities related to the provision of 

12 medical assistance under this section, including 

13 costs attributable to obtaining recoveries under 

14 subsection (g). 

15 ‘‘(2) DISREGARD OF LIMITS ON PAYMENTS TO

16 TERRITORIES.—The limitations on payment under 

17 subsections (f) and (g) of section 1108 shall not 

18 apply to Federal payments under this title that are 

19 based on the Federal medical assistance percentage 

20 described in paragraph (1), and such payments shall 

21 be disregarded in applying such subsections. 

22 ‘‘(g) PENALTY FOR FRAUDULENT APPLICATIONS.— 

23 ‘‘(1) INDIVIDUAL LIABLE FOR COSTS.—If a 

24 State, as the result of verification activities con25 ducted by the State or otherwise, determines after a 


ddrumheller on DSK120RN23PROD with BILLS
27 

•HR 6029 IH

1 fair hearing that an individual has knowingly made 

2 a false attestation in an application for medical as3 sistance as a relief-eligible survivor of a disaster 

4 under this section, the State shall, subject to para5 graph (2), seek recovery from the individual for the 

6 full amount of the cost of medical assistance pro7 vided to the individual under this section. 

8 ‘‘(2) EXCEPTION.—The Secretary shall exempt 

9 a State from the requirement to seek recovery from 

10 an individual under paragraph (1) if the Secretary 

11 determines that it would not be cost-effective for the 

12 State to do so. 

13 ‘‘(3) REIMBURSEMENT TO THE FEDERAL GOV14 ERNMENT.—Amounts expended by a State for med15 ical assistance provided to an individual under this 

16 section that are subsequently recovered by the State 

17 under this subsection shall be treated as an overpay18 ment under this title to the extent that payments 

19 were made to the State for such amounts. 

20 ‘‘(h) EXEMPTION FROM ERROR RATE PENALTIES.— 

21 All payments attributable to providing medical assistance 

22 to relief-eligible survivors of disasters in accordance with 

23 this section shall be disregarded for purposes of section 

24 1903(u).’’. 


ddrumheller on DSK120RN23PROD with BILLS
28 

•HR 6029 IH

1 SEC. 3. PROMOTING EFFECTIVE AND INNOVATIVE STATE 

2 RESPONSES TO INCREASED DEMAND FOR 

3 MEDICAL ASSISTANCE FOLLOWING A DIS4 ASTER. 

5 (a) GUIDANCE ON INCREASING ACCESS TO PRO6 VIDERS.—Not later than January 1, 2023, the Secretary 

7 of Health and Human Services (in this section referred 

8 to as the ‘‘Secretary’’) shall issue (and update as the Sec9 retary determines necessary) guidance to State Medicaid 

10 directors on best practices for— 

11 (1) expediting the approval of providers under 

12 a State Medicaid plan under title XIX of the Social 

13 Security Act (42 U.S.C. 1396 et seq.), or waiver of 

14 such plan, after a disaster to meet increased demand 

15 for medical assistance under the plan or waiver from 

16 relief-eligible survivors (as defined in section 

17 1948(b)(5) of such Act) of disasters; and 

18 (2) using out-of-State providers to provide care 

19 to relief-eligible survivors of a disaster under the 

20 plan or waiver. 

21 (b) TECHNICAL ASSISTANCE AND SUPPORT FOR IN22 NOVATIVE STATE STRATEGIES TO RESPOND TO IN23 CREASED DEMAND FOR MEDICAL ASSISTANCE FOL24 LOWING A DISASTERS.— 

25 (1) IN GENERAL.—The Secretary shall provide 

26 technical assistance and support to States to develop 


ddrumheller on DSK120RN23PROD with BILLS
29 

•HR 6029 IH

1 or expand infrastructure, strategies, or innovations 

2 (including through State Medicaid demonstration 

3 projects) to provide medical assistance under a State 

4 Medicaid plan under title XIX of the Social Security 

5 Act (42 U.S.C. 1396 et seq.), or a waiver of such 

6 a plan, to relief-eligible survivors (as defined in sec7 tion 1948(b)(5) of such Act) of disasters. 

8 (2) REPORT.—Not later than 180 days after 

9 the date of enactment of this Act, the Secretary 

10 shall issue a report to Congress detailing a plan of 

11 action to carry out the requirements of paragraph 

12 (1). 

13 (c) HCBS EMERGENCY RESPONSE CORPS GRANT

14 PROGRAM.— 

15 (1) IN GENERAL.—The Secretary shall award 

16 grants under this subsection to States for the pur17 pose of establishing or operating HCBS emergency 

18 response corps that meet the requirements of para19 graph (2) to provide medical assistance for home 

20 and community-based services under a State Med21 icaid plan under title XIX of the Social Security Act 

22 (42 U.S.C. 1396 et seq.) to relief-eligible survivors 

23 (as defined in section 1948(b)(5) of such Act) of dis24 asters. 


ddrumheller on DSK120RN23PROD with BILLS
30 

•HR 6029 IH

1 (2) HOME AND COMMUNITY-BASED SERVICES

2 EMERGENCY RESPONSE CORPS.—An HCBS emer3 gency response corps meets the requirements of this 

4 paragraph if it satisfies the following requirements: 

5 (A) The corps serves a State with a history 

6 of hosting individuals who are forced to relocate 

7 to the State from another State due to a dis8 aster (as determined by the Secretary). 

9 (B) The corps is composed of representa10 tives from each of the following: 

11 (i) Voluntary organizations delivering 

12 assistance. 

13 (ii) Area agencies on aging (as defined 

14 in section 102 of the Older Americans Act 

15 of 1965 (42 U.S.C. 3002)). 

16 (iii) The Medicare program under title 

17 XVIII of the Social Security Act (42 

18 U.S.C. 1395 et seq.). 

19 (iv) The State agency responsible for 

20 administering the State Medicaid program 

21 under title XIX of the Social Security Act 

22 (42 U.S.C. 1396 et seq.). 

23 (v) State agencies serving older adults 

24 and people with disabilities. 

25 (vi) Nonprofit service providers. 


ddrumheller on DSK120RN23PROD with BILLS
31 

•HR 6029 IH

1 (vii) Individuals who are enrolled in 

2 the State Medicaid program under title 

3 XIX of the Social Security Act (42 U.S.C. 

4 1396 et seq.) or the Children’s Health In5 surance Program under title XXI of the 

6 Social Security Act (42 U.S.C. 1397aa et 

7 seq.). 

8 (viii) Centers for independent living, 

9 as described in part C of title VII of the 

10 Rehabilitation Act of 1973 (29 U.S.C. 

11 796f et seq.). 

12 (ix) Other organizations that address 

13 the needs of older adults and people with 

14 disabilities. 

15 (C) The corps is led by a representative of 

16 a State or nonprofit agency serving older adults 

17 or people with disabilities. 

18 (D) The corps operates under a plan to 

19 meet the acute and long-term services and sup20 port needs of relief-eligible survivors (as defined 

21 in section 1948(b)(5) of the Social Security 

22 Act) of disasters, and is provided with the re23 sources necessary to execute such plan. 

24 (3) GRANTS.— 


ddrumheller on DSK120RN23PROD with BILLS
32 

•HR 6029 IH

1 (A) LIMITATION.—The Secretary may 

2 award a grant under this subsection to up to 5 

3 States. 

4 (B) TERM OF GRANTS.—Grants under this 

5 subsection shall be made for a term of 2 years. 

6 (4) AUTHORIZATION.—There are authorized to 

7 be appropriated to carry out this subsection, 

8 $10,000,000 for each of fiscal years 2022 through 

9 2027, to remain available until expended. 

10 SEC. 4. TARGETED MEDICAID RELIEF FOR DIRECT IMPACT 

11 AREAS. 

12 (a) 100 PERCENT FEDERAL MATCHING PAYMENTS

13 FOR MEDICAL ASSISTANCE PROVIDED IN A DIRECT IM14 PACT AREA.— 

15 (1) IN GENERAL.—Section 1905 of the Social 

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

17 (A) in subsection (b), by striking ‘‘and 

18 (ii)’’ and inserting ‘‘(ii), and (jj)’’; and 

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

20 subsection: 

21 ‘‘(jj) 100 PERCENT FMAP FOR ALL MEDICAL AS22 SISTANCE PROVIDED IN DISASTER DIRECT IMPACT

23 AREAS.—Notwithstanding subsection (b), the Federal 

24 medical assistance percentage for a State and fiscal year 

25 shall be equal to 100 percent with respect to amounts exVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
33 

•HR 6029 IH

1 pended by the State during the fiscal year for medical as2 sistance for an individual who, during the fiscal quarter 

3 in which the assistance is provided to the individual, is 

4 a resident of a direct impact area of a disaster during the 

5 disaster’s relief coverage period (as such terms are defined 

6 in section 1948).’’. 

7 (2) EXCLUSION OF ENHANCED PAYMENTS

8 FROM TERRITORIAL CAPS.—Notwithstanding any 

9 other provision of law, for purposes of section 1108 

10 of the Social Security Act (42 U.S.C. 1308), with re11 spect to any additional amount paid to a territory as 

12 a result of the application of section 1905(jj) of the 

13 Social Security Act (42 U.S.C. 1396d(jj))— 

14 (A) the limitation on payments to terri15 tories under subsections (f) and (g) of such sec16 tion 1108 shall not apply to such additional 

17 amounts; and 

18 (B) such additional amounts shall be dis19 regarded in applying such subsections. 

20 (3) APPLICATION TO CHIP.— 

21 (A) IN GENERAL.—Section 2105(c) of the 

22 Social Security Act (42 U.S.C. 1397ee(a)) is 

23 amended by adding at the end the following 

24 new paragraph: 


ddrumheller on DSK120RN23PROD with BILLS
34 

•HR 6029 IH

1 ‘‘(13) 100 PERCENT MATCH FOR ASSISTANCE

2 PROVIDED IN DISASTER DIRECT IMPACT AREAS.— 

3 Notwithstanding subsection (b), the enhanced 

4 FMAP for a State, with respect to payments under 

5 subsection (a) for expenditures under the State plan 

6 for child health assistance for targeted low-income 

7 children or pregnancy-related assistance for individ8 uals who are targeted low-income women that is pro9 vided to such a child or individual who, at the time 

10 the assistance is provided, is a resident of a direct 

11 impact area of a disaster during the disaster’s relief 

12 coverage period (as such terms are defined in section 

13 1948) shall be equal to 100 percent.’’. 

14 (B) ADJUSTMENT OF CHIP ALLOT15 MENTS.—Section 2104(m) of the Social Secu16 rity Act (42 U.S.C. 1397dd(m)) is amended— 

17 (i) in paragraph (2)(B), by striking ‘‘ 

18 and (12)’’ and inserting ‘‘(12), and (13)’’; 

19 and 

20 (ii) by adding at the end the following 

21 new paragraph: 

22 ‘‘(13) ADJUSTING ALLOTMENTS TO ACCOUNT

23 FOR INCREASED FEDERAL PAYMENTS FOR ASSIST24 ANCE PROVIDED IN DISASTER DIRECT IMPACT

25 AREAS.—If a State (including the District of ColumVerDate Sep 11 2014 21:01 Nov 06, 2023 Jkt 049200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H6029.IH H6029

ddrumheller on DSK120RN23PROD with BILLS
35 

•HR 6029 IH

1 bia and each commonwealth and territory) receives 

2 a payment for a fiscal year under subsection (a) of 

3 section 2105 for expenditures that are subject to the 

4 enhanced FMAP specified under subsection (c)(13) 

5 of such section— 

6 ‘‘(A) the amount of the allotment deter7 mined for the State under this subsection for 

8 such fiscal year shall be increased by the prod9 uct of— 

10 ‘‘(i) the amount of such expenditures 

11 that the State is projected to make for 

12 such fiscal year; and 

13 ‘‘(ii) a percentage equal to 100 per14 cent reduced by a number of percentage 

15 points equal to the enhanced FMAP deter16 mined for the State and fiscal year under 

17 subsection (b) of section 2105; and 

18 ‘‘(B) once actual expenditures for the fiscal 

19 year are available, the amount of such allot20 ment, as increased under subparagraph (A), 

21 shall be further increased or reduced, as appro22 priate, on the basis of the difference between— 

23 ‘‘(i) the amount of the increase deter24 mined under subparagraph (A); and 

25 ‘‘(ii) the product of— 


ddrumheller on DSK120RN23PROD with BILLS
36 

•HR 6029 IH

1 ‘‘(I) the actual amount of State 

2 expenditures that are subject to the 

3 enhanced FMAP specified under sec4 tion 2105(c)(13); and 

5 ‘‘(II) the percentage determined 

6 for the State under subparagraph 

7 (A)(ii).’’. 

8 (b) MORATORIUM ON REDETERMINATIONS.—During 

9 the relief coverage period (as defined in paragraph (4) of 

10 section 1948(b) of the Social Security Act, as added by 

11 section 2)) of a disaster, a State that contains a direct 

12 impact area (as defined in paragraph (2) of such section) 

13 of the disaster shall not be required to conduct eligibility 

14 redeterminations under the State’s plans or waivers of 

15 such plans under title XIX or XXI of such Act (42 U.S.C. 

16 1396 et seq., 1397aa) with respect to individuals who re17 side in such area. 

18 SEC. 5. AUTHORITY TO WAIVE REQUIREMENTS DURING NA19 TIONAL EMERGENCIES WITH RESPECT TO 

20 EVACUEES FROM AN EMERGENCY AREA. 

21 Section 1135(g)(1) of the Social Security Act (42 

22 U.S.C. 1320b–5(g)(1)) is amended— 

23 (1) by redesignating subparagraphs (A) and 

24 (B) as clauses (i) and (ii), respectively; 


ddrumheller on DSK120RN23PROD with BILLS
37 

•HR 6029 IH

1 (2) by striking ‘‘An ‘emergency area’ ’’ and in2 serting the following: 

3 ‘‘(A) IN GENERAL.—An emergency area’’; 

4 and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(B) ADDITIONAL AREAS.—Any geographical 

8 area in which the Secretary determines there are a 

9 significant number of evacuees from an area de10 scribed in subparagraph (A) shall also be considered 

11 to be an ‘emergency area’ for purposes of this sec12 tion.’’. 

13 SEC. 6. EXCLUSION OF DISASTER RELIEF COVERAGE PE14 RIOD IN COMPUTING MEDICARE PART B 

15 LATE ENROLLMENT PERIOD. 

16 Section 1839(b) of such Act (42 U.S.C. 1395r(b)) is 

17 amended, in the second sentence, by inserting before the 

18 period at the end the following: ‘‘or, in the case of an indi19 vidual who is a survivor of a disaster (as defined in para20 graph (6) of section 1948(b)), any month any part of 

21 which is within the relief coverage period (as defined in 

22 paragraph (4) of such section) of such disaster’’. 


ddrumheller on DSK120RN23PROD with BILLS
38 

•HR 6029 IH

1 SEC. 7. EFFECTIVE DATE. 

2 (a) IN GENERAL.—Subject to subsection (b), this Act 

3 and the amendments made by this Act shall take effect 

4 on the date of enactment of this Act. 

5 (b) DELAY PERMITTED IF STATE LEGISLATION RE6 QUIRED.—In the case of a State plan approved under title 

7 XIX of the Social Security Act which the Secretary of 

8 Health and Human Services determines requires State 

9 legislation (other than legislation appropriating funds) in 

10 order for the plan to meet the additional requirement im11 posed by this section, the State plan shall not be regarded 

12 as failing to comply with the requirements of such title 

13 solely on the basis of the failure of the plan to meet such 

14 additional requirement before the 1st day of the 1st cal15 endar quarter beginning after the close of the 1st regular 

16 session of the State legislature that ends after the 1-year 

17 period beginning with the date of the enactment of this 

18 section. For purposes of the preceding sentence, in the 

19 case of a State that has a 2-year legislative session, each 

20 year of the session is deemed to be a separate regular ses21 sion of the State legislature. 

22 SEC. 8. IMPACT EVALUATION AND REPORTING. 

23 (a) IN GENERAL.—Not later than 24 months after 

24 the date of enactment of this Act, the Secretary of Health 

25 and Human Services shall enter into a 5-year agreement 

26 through a contract, grant, or cooperative agreement with 


ddrumheller on DSK120RN23PROD with BILLS
39 

•HR 6029 IH

1 an independent nonprofit entity experienced in conducting 

2 evaluations of program and systems change efforts to— 

3 (1) conduct a multi-year evaluation on the im4 pact of this Act, with respect to relief-eligible sur5 vivors (including people with disabilities and preg6 nant individuals); and 

7 (2) prepare the reports described in subsection 

8 (c). 

9 (b) EVALUATION.—In carrying out subsection (a)(1), 

10 the entity awarded a contract, grant, or cooperative agree11 ment under this section shall evaluate at a minimum— 

12 (1) the availability of and access to Medicaid 

13 services for relief-eligible survivors under the Med14 icaid program nationally and in each State, territory 

15 and tribal organization, including scope and cov16 erage of services, provision of home and community17 based services and extended mental health and care 

18 coordination services; and provider capacity; 

19 (2) the demographics of individuals receiving 

20 these benefits, including individuals with disabilities 

21 and pregnant individuals; and 

22 (3) actions taken by States to comply with this 

23 Act, including coordination of efforts between 

24 States, coordination between State agencies and 


ddrumheller on DSK120RN23PROD with BILLS
40 

•HR 6029 IH

1 qualified providers, and activities of HCBS emer2 gency response corps (as described in section 3(c)). 

3 (c) REPORTS.—The Secretary of Health and Human 

4 Services shall submit to the Committee on Finance of the 

5 Senate, the Special Committee on Aging of the Senate, 

6 the Committee on Energy and Commerce of the House 

7 of Representatives, and the Committee on Ways and 

8 Means of the House of Representatives the following re9 ports on the evaluation conducted under subsection (a)(1): 

10 (1) An interim report on the evaluation, to be 

11 submitted not later than 3 years after the evaluation 

12 commences. 

13 (2) A follow-up report on such evaluation, to be 

14 submitted not later than 24 months after the date 

15 on which the interim report is issued. 

Æ 


ddrumheller on DSK120RN23PROD with BILLS