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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3253 Engrossed in House (EH)]

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116th CONGRESS
  1st Session
                                H. R. 3253

_______________________________________________________________________

                                 AN ACT

 
To provide for certain extensions with respect to the Medicaid program 
  under title XIX of the Social Security Act, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Empowering 
Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 
2019''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; Table of contents.
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 
                            community-based 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.
Sec. 8. Determination of budgetary effects.

SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 
              DEMONSTRATION.

    (a) In General.--
            (1) Funding.--Section 6071(h) of the Deficit Reduction Act 
        of 2005 (42 U.S.C. 1396a note) is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (E), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (F)--
                                    (I) by striking ``subject to 
                                paragraph (3), 132,000,000'' and 
                                inserting ``$132,000,000''; and
                                    (II) by striking the period at the 
                                end and inserting a semicolon; and
                            (iii) by adding at the end the following 
                        new subparagraphs:
                    ``(G) $417,000,000 for fiscal year 2020;
                    ``(H) $450,000,000 for each of fiscal years 2021 
                through 2023; and
                    ``(I) $225,000,000 for fiscal year 2024.'';
                    (B) in paragraph (2)--
                            (i) by striking ``Subject to paragraph (3), 
                        amounts'' and inserting ``Amounts''; and
                            (ii) by striking ``2021'' and inserting 
                        ``2024''; and
                    (C) by striking paragraph (3).
            (2) Research and evaluation.--Section 6071(g) of the 
        Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
        amended--
                    (A) in paragraph (2), by striking ``2016'' and 
                inserting ``2024''; and
                    (B) in paragraph (3), by inserting ``and for each 
                of fiscal years 2019 through 2024,'' after ``2016,''.
    (b) Changes to Institutional Residency Period Requirement.--
            (1) In general.--Section 6071(b)(2) of the Deficit 
        Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
                    (A) in subparagraph (A)(i), by striking ``90'' and 
                inserting ``60''; and
                    (B) by striking the flush sentence after 
                subparagraph (B).
            (2) Effective date.--The amendments made by paragraph (1) 
        shall take effect on the date that is 30 days after the date of 
        the enactment of this Act.
    (c) Updates to State Application Requirements.--Section 6071(c) of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
            (1) in paragraph (3), by striking ``, which shall include'' 
        and all that follows through ``2007'';
            (2) in paragraph (7)--
                    (A) in the paragraph heading, by striking 
                ``Rebalancing'' and inserting ``Expenditures'';
                    (B) in subparagraph (A), by adding ``and'' at the 
                end; and
                    (C) in subparagraph (B)--
                            (i) in clause (i), by striking ``and'' at 
                        the end;
                            (ii) in clause (ii), by striking the period 
                        at the end and inserting a semicolon; and
                            (iii) by adding at the end the following:
                    ``(iii) include a work plan that describes for each 
                Federal fiscal year that occurs during the proposed MFP 
                demonstration project--
                            ``(I) the use of grant funds for each 
                        proposed initiative that is designed to 
                        accomplish the objective described in 
                        subsection (a)(1), including a funding source 
                        for each activity that is part of each such 
                        proposed initiative;
                            ``(II) an evaluation plan that identifies 
                        expected results for each such proposed 
                        initiative; and
                            ``(III) a sustainability plan for 
                        components of such proposed initiatives that 
                        are intended to improve transitions, which 
                        shall be updated with actual expenditure 
                        information for each Federal fiscal year that 
                        occurs during the MFP demonstration project; 
                        and
                    ``(iv) contain assurances that grant funds used to 
                accomplish the objective described in subsection (a)(1) 
                shall be obligated not later than 24 months after the 
                date on which the funds are awarded and shall be 
                expended not later than 60 months after the date on 
                which the funds are awarded (unless the Secretary 
                approves a waiver of either such requirement).''; and
            (3) in paragraph (13)--
                    (A) in subparagraph (A), by striking ``; and'' and 
                inserting ``, and in such manner as will meet the 
                reporting requirements set forth for the Transformed 
                Medicaid Statistical Management Information System (T-
                MSIS);'';
                    (B) by redesignating subparagraph (B) as 
                subparagraph (D); and
                    (C) by inserting after subparagraph (A) the 
                following:
                    ``(B) the State shall report on a quarterly basis 
                on the use of grant funds by distinct activity, as 
                described in the approved work plan, and by specific 
                population as targeted by the State;
                    ``(C) if the State fails to report the information 
                required under subparagraph (B), fails to report such 
                information on a quarterly basis, or fails to make 
                progress under the approved work plan, the State shall 
                implement a corrective action plan and any lack of 
                progress under the approved work plan may result in 
                withholding of grant funds made available to the State; 
                and''.
    (d) Funding for Quality Assurance and Improvement; Technical 
Assistance; Oversight.--Section 6071(f) of the Deficit Reduction Act of 
2005 (42 U.S.C. 1396a note) is amended by striking paragraph (2) and 
inserting the following:
            ``(2) Funding.--From the amounts appropriated under 
        subsection (h)(1) for each of fiscal years 2019 through 2024, 
        $1,000,000 shall be available to the Secretary for each such 
        fiscal year to carry out this subsection.''.
    (e) Best Practices Evaluation.--Section 6071 of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by adding at 
the end the following:
    ``(i) Best Practices.--
            ``(1) Report.--The Secretary, directly or through grant or 
        contract, shall submit a report to the President and Congress 
        not later than September 30, 2020, that contains findings and 
        conclusions on best practices from the State MFP demonstration 
        projects carried out with grants made under this section. The 
        report shall include information and analyses with respect to 
        the following:
                    ``(A) The most effective State strategies for 
                transitioning beneficiaries from institutional to 
                qualified community settings carried out under the 
                State MFP demonstration projects and how such 
                strategies may vary for different types of 
                beneficiaries, such as beneficiaries who are aged, 
                physically disabled, intellectually or developmentally 
                disabled, or individuals with serious mental illnesses, 
                and other targeted waiver beneficiary populations.
                    ``(B) The most common and the most effective State 
                uses of grant funds carried out under the State MFP 
                demonstration projects for transitioning beneficiaries 
                from institutional to qualified community settings and 
                improving health outcomes, including differentiating 
                funding for current initiatives that are designed for 
                such purpose and funding for proposed initiatives that 
                are designed for such purpose.
                    ``(C) The most effective State approaches carried 
                out under State MFP demonstration projects for 
                improving person-centered care and planning.
                    ``(D) Identification of program, financing, and 
                other flexibilities available under the State MFP 
                demonstration projects, that are not available under 
                the traditional Medicaid program, and which directly 
                contributed to successful transitions and improved 
                health outcomes under the State MFP demonstration 
                projects.
                    ``(E) State strategies and financing mechanisms for 
                effective coordination of housing financed or supported 
                under State MFP demonstration projects with local 
                housing authorities and other resources.
                    ``(F) Effective State approaches for delivering 
                Money Follows the Person transition services through 
                managed care entities.
                    ``(G) Other best practices and effective transition 
                strategies demonstrated by States with approved MFP 
                demonstration projects, as determined by the Secretary.
                    ``(H) Identification and analyses of opportunities 
                and challenges to integrating effective Money Follows 
                the Person practices and State strategies into the 
                traditional Medicaid program.
            ``(2) Collaboration.--In preparing the report required 
        under this subsection, the Secretary shall collect and 
        incorporate information from States with approved MFP 
        demonstration projects and beneficiaries participating in such 
        projects, and providers participating in such projects.
            ``(3) Funding.--From the amounts appropriated under 
        subsection (h)(1) for each of fiscal years 2020 and 2021, not 
        more than $300,000 shall be available to the Secretary for each 
        such fiscal year to carry out this subsection.''.
    (f) MACPAC Report on Qualified Settings Criteria.--Section 6071 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note), as amended by 
subsection (e), is further amended by adding at the end the following:
    ``(j) MACPAC Report.--Prior to the final implementation date 
established by the Secretary for the criteria established for home and 
community-based settings in section 441.301(c)(4) of title 42, Code of 
Federal Regulations, as part of final implementation of the Home and 
Community Based Services (HCBS) Final Rule published on January 16, 
2014 (79 Fed. Reg. 2947) (referred to in this subsection as the `HCBS 
final rule'), the Medicaid and CHIP Payment and Access Commission 
(MACPAC) shall submit to Congress a report that--
            ``(1) identifies the types of home and community-based 
        settings and associated services that are available to eligible 
        individuals in both the MFP demonstration program and sites in 
        compliance with the HCBS final rule; and
            ``(2) if determined appropriate by the Commission, 
        recommends policies to align the criteria for a qualified 
        residence under subsection (b)(6) (as in effect on October 1, 
        2017) with the criteria in the HCBS final rule.''.
    (g) Application to Current Projects.--Not later than 1 year after 
the date of the enactment of this Act, any State with an approved MFP 
demonstration project under section 6071 of the Deficit Reduction Act 
of 2005 (42 U.S.C. 1396a note) on the date of the enactment of this Act 
shall submit a revised application to the Secretary that contains the 
same information and assurances as are required for any new State 
applicant under the amendments made by this section.

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.

    (a) In General.--Section 1903(q)(4)(A)(ii) of the Social Security 
Act (42 U.S.C. 1396b(q)(4)(A)(ii)) is amended by inserting after 
``patients residing in board and care facilities'' the following: ``and 
of patients (who are receiving medical assistance under the State plan 
under this title) in a noninstitutional or other setting''.
    (b) Availability of Funding.--Section 1903(a)(6) of the Social 
Security Act (42 U.S.C. 1396b(a)(6)) is amended, in the matter 
following subparagraph (B), by striking ``(as found necessary by the 
Secretary for the elimination of fraud in the provision and 
administration of medical assistance provided under the State plan)''.

SEC. 4. EXTENSION OF PROTECTION FOR MEDICAID RECIPIENTS OF HOME AND 
              COMMUNITY-BASED SERVICES AGAINST SPOUSAL IMPOVERISHMENT.

    (a) In General.--Section 2404 of Public Law 111-148 (42 U.S.C. 
1396r-5 note) is amended by striking ``September 30, 2019'' and 
inserting ``March 31, 2024''.
    (b) Rule of Construction.--Nothing in section 2404 of Public Law 
111-148 (42 U.S.C. 1396r-5 note), section 1924 of the Social Security 
Act (42 U.S.C. 1396r-5), or section 1902(a)(17) of such Act (42 U.S.C. 
1396a(a)(17)) shall be construed as prohibiting a State from applying 
an income or resource disregard authorized under section 1902(r)(2) of 
such Act (42 U.S.C. 1396a(r)(2))--
            (1) to the income or resources of individuals described in 
        section 1902(a)(10)(A)(ii)(VI) of such Act (42 U.S.C. 
        1396a(a)(10)(A)(ii)(VI)) (including a disregard of the income 
        or resources of such individual's spouse); or
            (2) on the basis of an individual's need for home and 
        community-based services authorized under subsection (c), (d), 
        (i), or (k) of section 1915 of such Act (42 U.S.C. 1396n) or 
        under section 1115 of such Act (42 U.S.C. 1315).

SEC. 5. EXTENSION OF THE COMMUNITY MENTAL HEALTH SERVICES DEMONSTRATION 
              PROGRAM.

    Section 223(d) of the Protecting Access to Medicare Act of 2014 (42 
U.S.C. 1396a note) is amended--
            (1) in paragraph (3), by striking ``June 30, 2019'' and 
        inserting ``December 31, 2021''; and
            (2) in paragraph (7)(B), by striking ``December 31, 2021'' 
        and inserting ``June 30, 2021''.

SEC. 6. PREVENTING INAPPROPRIATELY LOW REBATES UNDER MEDICAID DRUG 
              REBATE PROGRAM.

    (a) Prohibiting Manufacturers From Blending Average Manufacturer 
Price of Brand Drug and Any Authorized Generic of Such Drug.--Section 
1927(k)(1)(C) of the Social Security Act (42 U.S.C. 1396r-8(k)(1)(C)) 
is amended--
            (1) in the subparagraph heading, by striking ``Inclusion'' 
        and inserting ``Exclusion'';
            (2) by striking ``a new drug application'' and inserting 
        ``the manufacturer's new drug application''; and
            (3) by striking ``inclusive'' and inserting ``exclusive''.
    (b) Eliminating Manufacturers From Definition of Wholesaler.--
Section 1927(k)(11) of the Social Security Act (42 U.S.C. 1396r-
8(k)(11)) is amended--
            (1) by striking ``manufacturers,''; and
            (2) by striking ``manufacturer's and''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to covered outpatient drugs dispensed on or after 
January 1, 2020.

SEC. 7. MEDICAID IMPROVEMENT FUND.

    Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w-
1(b)(1)) is amended by striking ``$6,000,000'' and inserting 
``$45,500,000''.

SEC. 8. DETERMINATION OF BUDGETARY EFFECTS.

    The budgetary effects of this Act, for the purpose of complying 
with the Statutory Pay-As-You-Go Act of 2010, shall be determined by 
reference to the latest statement titled ``Budgetary Effects of PAYGO 
Legislation'' for this Act, submitted for printing in the Congressional 
Record by the Chairman of the House Budget Committee, provided that 
such statement has been submitted prior to the vote on passage.

            Passed the House of Representatives June 18, 2019.

            Attest:

                                                                 Clerk.
116th CONGRESS

  1st Session

                               H. R. 3253

_______________________________________________________________________

                                 AN ACT

To provide for certain extensions with respect to the Medicaid program 
  under title XIX of the Social Security Act, and for other purposes.
```