I 

116TH CONGRESS 

1ST SESSION H. R. 3253 

To provide for certain extensions with respect to the Medicaid program 

under title XIX of the Social Security Act, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 13, 2019 

Mrs. DINGELL (for herself, Mr. GUTHRIE, Mr. PALLONE, Mr. WALDEN, Ms. 

ESHOO, Mr. BURGESS, Mr. UPTON, Mr. WELCH, Mr. WALBERG, and Mr. 

KENNEDY) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To provide for certain extensions with respect to the Medicaid program under title XIX of the Social Security 

Act, 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 ‘‘Empowering Beneficiaries, Ensuring Access, and 

6 Strengthening Accountability Act of 2019’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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Sec. 2. Extension of Money Follows the Person Rebalancing Demonstration. 

Sec. 3. Clarifying authority of State Medicaid fraud and abuse control units to 

investigate and prosecute cases of Medicaid patient abuse and 

neglect in any setting. 

Sec. 4. Extension of protection for Medicaid recipients of home and communitybased services against spousal impoverishment. 

Sec. 5. Extension of the Community Mental Health Services Demonstration 

Program. 

Sec. 6. Preventing inappropriately low rebates under Medicaid drug rebate program. 

Sec. 7. Medicaid Improvement Fund. 

1 SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON RE2 BALANCING DEMONSTRATION. 

3 (a) IN GENERAL.— 

4 (1) FUNDING.—Section 6071(h) of the Deficit 

5 Reduction Act of 2005 (42 U.S.C. 1396a note) is 

6 amended— 

7 (A) in paragraph (1)— 

8 (i) in subparagraph (E), by striking 

9 ‘‘and’’ at the end; 

10 (ii) in subparagraph (F)— 

11 (I) by striking ‘‘subject to para12 graph (3), 132,000,000’’ and insert13 ing ‘‘$132,000,000’’; and 

14 (II) by striking the period at the 

15 end and inserting a semicolon; and 

16 (iii) by adding at the end the fol17 lowing new subparagraphs: 

18 ‘‘(G) $417,000,000 for fiscal year 2020; 

19 ‘‘(H) $450,000,000 for each of fiscal years 

20 2021 through 2023; and 


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1 ‘‘(I) $225,000,000 for fiscal year 2024.’’; 

2 (B) in paragraph (2)— 

3 (i) by striking ‘‘Subject to paragraph 

4 (3), amounts’’ and inserting ‘‘Amounts’’; 

5 and 

6 (ii) by striking ‘‘2021’’ and inserting 

7 ‘‘2024’’; and 

8 (C) by striking paragraph (3). 

9 (2) RESEARCH AND EVALUATION.—Section 

10 6071(g) of the Deficit Reduction Act of 2005 (42 

11 U.S.C. 1396a note) is amended— 

12 (A) in paragraph (2), by striking ‘‘2016’’ 

13 and inserting ‘‘2024’’; and 

14 (B) in paragraph (3), by inserting ‘‘and 

15 for each of fiscal years 2019 through 2024,’’ 

16 after ‘‘2016,’’. 

17 (b) CHANGES TO INSTITUTIONAL RESIDENCY PE18 RIOD REQUIREMENT.— 

19 (1) IN GENERAL.—Section 6071(b)(2) of the 

20 Deficit Reduction Act of 2005 (42 U.S.C. 1396a 

21 note) is amended— 

22 (A) in subparagraph (A)(i), by striking 

23 ‘‘90’’ and inserting ‘‘60’’; and 

24 (B) by striking the flush sentence after 

25 subparagraph (B). 


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1 (2) EFFECTIVE DATE.—The amendments made 

2 by paragraph (1) shall take effect on the date that 

3 is 30 days after the date of the enactment of this 

4 Act. 

5 (c) UPDATES TO STATE APPLICATION REQUIRE6 MENTS.—Section 6071(c) of the Deficit Reduction Act of 

7 2005 (42 U.S.C. 1396a note) is amended— 

8 (1) in paragraph (3), by striking ‘‘, which shall 

9 include’’ and all that follows through ‘‘2007’’; 

10 (2) in paragraph (7)— 

11 (A) in the paragraph heading, by striking 

12 ‘‘REBALANCING’’ and inserting ‘‘EXPENDI13 TURES’’; 

14 (B) in subparagraph (A), by adding ‘‘and’’ 

15 at the end; and 

16 (C) in subparagraph (B)— 

17 (i) in clause (i), by striking ‘‘and’’ at 

18 the end; 

19 (ii) in clause (ii), by striking the pe20 riod at the end and inserting a semicolon; 

21 and 

22 (iii) by adding at the end the fol23 lowing: 


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1 ‘‘(iii) include a work plan that describes 

2 for each Federal fiscal year that occurs during 

3 the proposed MFP demonstration project— 

4 ‘‘(I) the use of grant funds for each 

5 proposed initiative that is designed to ac6 complish the objective described in sub7 section (a)(1), including a funding source 

8 for each activity that is part of each such 

9 proposed initiative; 

10 ‘‘(II) an evaluation plan that identi11 fies expected results for each such pro12 posed initiative; and 

13 ‘‘(III) a sustainability plan for compo14 nents of such proposed initiatives that are 

15 intended to improve transitions, which 

16 shall be updated with actual expenditure 

17 information for each Federal fiscal year 

18 that occurs during the MFP demonstration 

19 project; and 

20 ‘‘(iv) contain assurances that grant funds 

21 used to accomplish the objective described in 

22 subsection (a)(1) shall be obligated not later 

23 than 24 months after the date on which the 

24 funds are awarded and shall be expended not 

25 later than 60 months after the date on which 


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1 the funds are awarded (unless the Secretary ap2 proves a waiver of either such requirement).’’; 

3 and 

4 (3) in paragraph (13)— 

5 (A) in subparagraph (A), by striking ‘‘; 

6 and’’ and inserting ‘‘, and in such manner as 

7 will meet the reporting requirements set forth 

8 for the Transformed Medicaid Statistical Man9 agement Information System (T–MSIS);’’; 

10 (B) by redesignating subparagraph (B) as 

11 subparagraph (D); and 

12 (C) by inserting after subparagraph (A) 

13 the following: 

14 ‘‘(B) the State shall report on a quarterly 

15 basis on the use of grant funds by distinct ac16 tivity, as described in the approved work plan, 

17 and by specific population as targeted by the 

18 State; 

19 ‘‘(C) if the State fails to report the infor20 mation required under subparagraph (B), fails 

21 to report such information on a quarterly basis, 

22 or fails to make progress under the approved 

23 work plan, the State shall implement a correc24 tive action plan and any lack of progress under 

25 the approved work plan may result in withVerDate Sep 11 2014 18:46 Jun 14, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3253.IH H3253

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1 holding of grant funds made available to the 

2 State; and’’. 

3 (d) FUNDING FOR QUALITY ASSURANCE AND IM4 PROVEMENT; TECHNICAL ASSISTANCE; OVERSIGHT.— 

5 Section 6071(f) of the Deficit Reduction Act of 2005 (42 

6 U.S.C. 1396a note) is amended by striking paragraph (2) 

7 and inserting the following: 

8 ‘‘(2) FUNDING.—From the amounts appro9 priated under subsection (h)(1) for each of fiscal 

10 years 2019 through 2024, $1,000,000 shall be avail11 able to the Secretary for each such fiscal year to 

12 carry out this subsection.’’. 

13 (e) BEST PRACTICES EVALUATION.—Section 6071 of 

14 the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 

15 is amended by adding at the end the following: 

16 ‘‘(i) BEST PRACTICES.— 

17 ‘‘(1) REPORT.—The Secretary, directly or 

18 through grant or contract, shall submit a report to 

19 the President and Congress not later than Sep20 tember 30, 2020, that contains findings and conclu21 sions on best practices from the State MFP dem22 onstration projects carried out with grants made 

23 under this section. The report shall include informa24 tion and analyses with respect to the following: 


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1 ‘‘(A) The most effective State strategies 

2 for transitioning beneficiaries from institutional 

3 to qualified community settings carried out 

4 under the State MFP demonstration projects 

5 and how such strategies may vary for different 

6 types of beneficiaries, such as beneficiaries who 

7 are aged, physically disabled, intellectually or 

8 developmentally disabled, or individuals with se9 rious mental illnesses, and other targeted waiv10 er beneficiary populations. 

11 ‘‘(B) The most common and the most ef12 fective State uses of grant funds carried out 

13 under the State MFP demonstration projects 

14 for transitioning beneficiaries from institutional 

15 to qualified community settings and improving 

16 health outcomes, including differentiating fund17 ing for current initiatives that are designed for 

18 such purpose and funding for proposed initia19 tives that are designed for such purpose. 

20 ‘‘(C) The most effective State approaches 

21 carried out under State MFP demonstration 

22 projects for improving person-centered care and 

23 planning. 

24 ‘‘(D) Identification of program, financing, 

25 and other flexibilities available under the State 


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1 MFP demonstration projects, that are not 

2 available under the traditional Medicaid pro3 gram, and which directly contributed to suc4 cessful transitions and improved health out5 comes under the State MFP demonstration 

6 projects. 

7 ‘‘(E) State strategies and financing mecha8 nisms for effective coordination of housing fi9 nanced or supported under State MFP dem10 onstration projects with local housing authori11 ties and other resources. 

12 ‘‘(F) Effective State approaches for deliv13 ering Money Follows the Person transition serv14 ices through managed care entities. 

15 ‘‘(G) Other best practices and effective 

16 transition strategies demonstrated by States 

17 with approved MFP demonstration projects, as 

18 determined by the Secretary. 

19 ‘‘(H) Identification and analyses of oppor20 tunities and challenges to integrating effective 

21 Money Follows the Person practices and State 

22 strategies into the traditional Medicaid pro23 gram. 

24 ‘‘(2) COLLABORATION.—In preparing the report 

25 required under this subsection, the Secretary shall 


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1 collect and incorporate information from States with 

2 approved MFP demonstration projects and bene3 ficiaries participating in such projects, and providers 

4 participating in such projects. 

5 ‘‘(3) FUNDING.—From the amounts appro6 priated under subsection (h)(1) for each of fiscal 

7 years 2020 and 2021, not more than $300,000 shall 

8 be available to the Secretary for each such fiscal 

9 year to carry out this subsection.’’. 

10 (f) MACPAC REPORT ON QUALIFIED SETTINGS CRI11 TERIA.—Section 6071 of the Deficit Reduction Act of 

12 2005 (42 U.S.C. 1396a note), as amended by subsection 

13 (e), is further amended by adding at the end the following: 

14 ‘‘(j) MACPAC REPORT.—Prior to the final imple15 mentation date established by the Secretary for the cri16 teria established for home and community-based settings 

17 in section 441.301(c)(4) of title 42, Code of Federal Regu18 lations, as part of final implementation of the Home and 

19 Community Based Services (HCBS) Final Rule published 

20 on January 16, 2014 (79 Fed. Reg. 2947) (referred to 

21 in this subsection as the ‘HCBS final rule’), the Medicaid 

22 and CHIP Payment and Access Commission (MACPAC) 

23 shall submit to Congress a report that— 

24 ‘‘(1) identifies the types of home and commu25 nity-based settings and associated services that are 


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1 available to eligible individuals in both the MFP 

2 demonstration program and sites in compliance with 

3 the HCBS final rule; and 

4 ‘‘(2) if determined appropriate by the Commis5 sion, recommends policies to align the criteria for a 

6 qualified residence under subsection (b)(6) (as in ef7 fect on October 1, 2017) with the criteria in the 

8 HCBS final rule.’’. 

9 (g) APPLICATION TO CURRENT PROJECTS.—Not 

10 later than 1 year after the date of the enactment of this 

11 Act, any State with an approved MFP demonstration 

12 project under section 6071 of the Deficit Reduction Act 

13 of 2005 (42 U.S.C. 1396a note) on the date of the enact14 ment of this Act shall submit a revised application to the 

15 Secretary that contains the same information and assur16 ances as are required for any new State applicant under 

17 the amendments made by this section. 

18 SEC. 3. CLARIFYING AUTHORITY OF STATE MEDICAID 

19 FRAUD AND ABUSE CONTROL UNITS TO IN20 VESTIGATE AND PROSECUTE CASES OF MED21 ICAID PATIENT ABUSE AND NEGLECT IN ANY 

22 SETTING. 

23 (a) IN GENERAL.—Section 1903(q)(4)(A)(ii) of the 

24 Social Security Act (42 U.S.C. 1396b(q)(4)(A)(ii)) is 

25 amended by inserting after ‘‘patients residing in board 


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1 and care facilities’’ the following: ‘‘and of patients (who 

2 are receiving medical assistance under the State plan 

3 under this title) in a noninstitutional or other setting’’. 

4 (b) AVAILABILITY OF FUNDING.—Section 1903(a)(6) 

5 of the Social Security Act (42 U.S.C. 1396b(a)(6)) is 

6 amended, in the matter following subparagraph (B), by 

7 striking ‘‘(as found necessary by the Secretary for the 

8 elimination of fraud in the provision and administration 

9 of medical assistance provided under the State plan)’’. 

10 SEC. 4. EXTENSION OF PROTECTION FOR MEDICAID RE11 CIPIENTS OF HOME AND COMMUNITY-BASED 

12 SERVICES AGAINST SPOUSAL IMPOVERISH13 MENT. 

14 Section 2404 of Public Law 111–148 (42 U.S.C. 

15 1396r–5 note) is amended by striking ‘‘September 30, 

16 2019’’ and inserting ‘‘March 31, 2024’’. 

17 SEC. 5. EXTENSION OF THE COMMUNITY MENTAL HEALTH 

18 SERVICES DEMONSTRATION PROGRAM. 

19 Section 223(d) of the Protecting Access to Medicare 

20 Act of 2014 (42 U.S.C. 1396a note) is amended— 

21 (1) in paragraph (3), by striking ‘‘June 30, 

22 2019’’ and inserting ‘‘December 31, 2021’’; and 

23 (2) in paragraph (7)(B), by striking ‘‘December 

24 31, 2021’’ and inserting ‘‘June 30, 2021’’. 


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1 SEC. 6. PREVENTING INAPPROPRIATELY LOW REBATES 

2 UNDER MEDICAID DRUG REBATE PROGRAM. 

3 (a) PROHIBITING MANUFACTURERS FROM BLEND4 ING AVERAGE MANUFACTURER PRICE OF BRAND DRUG

5 AND ANY AUTHORIZED GENERIC OF SUCH DRUG.—Sec6 tion 1927(k)(1)(C) of the Social Security Act (42 U.S.C. 

7 1396r–8(k)(1)(C)) is amended— 

8 (1) in the subparagraph heading, by striking 

9 ‘‘INCLUSION’’ and inserting ‘‘EXCLUSION’’; 

10 (2) by striking ‘‘a new drug application’’ and 

11 inserting ‘‘the manufacturer’s new drug applica12 tion’’; and 

13 (3) by striking ‘‘inclusive’’ and inserting ‘‘exclu14 sive’’. 

15 (b) ELIMINATING MANUFACTURERS FROM DEFINI16 TION OF WHOLESALER.—Section 1927(k)(11) of the So17 cial Security Act (42 U.S.C. 1396r–8(k)(11)) is amend18 ed— 

19 (1) by striking ‘‘manufacturers,’’; and 

20 (2) by striking ‘‘manufacturer’s and’’. 

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

22 this section shall apply with respect to covered outpatient 

23 drugs dispensed on or after January 1, 2020. 


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1 SEC. 7. MEDICAID IMPROVEMENT FUND. 

2 Section 1941(b)(1) of the Social Security Act (42 

3 U.S.C. 1396w–1(b)(1)) is amended by striking 

4 ‘‘$6,000,000’’ and inserting ‘‘$45,500,000’’. 

Æ 


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