II 

116TH CONGRESS 

1ST SESSION H. R. 3253 

IN THE SENATE OF THE UNITED STATES 

JUNE 19, 2019 

Received 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Empowering Beneficiaries, Ensuring Access, and 

4 Strengthening Accountability Act of 2019’’. 

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

6 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 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. 

Sec. 8. Determination of budgetary effects. 

7 SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON RE8 BALANCING DEMONSTRATION. 

9 (a) IN GENERAL.— 

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

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

12 amended— 

13 (A) in paragraph (1)— 

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

15 ‘‘and’’ at the end; 

16 (ii) in subparagraph (F)— 

17 (I) by striking ‘‘subject to para18 graph (3), 132,000,000’’ and insert19 ing ‘‘$132,000,000’’; and 


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1 (II) by striking the period at the 

2 end and inserting a semicolon; and 

3 (iii) by adding at the end the fol4 lowing new subparagraphs: 

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

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

7 2021 through 2023; and 

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

9 (B) in paragraph (2)— 

10 (i) by striking ‘‘Subject to paragraph 

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

12 and 

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

14 ‘‘2024’’; and 

15 (C) by striking paragraph (3). 

16 (2) RESEARCH AND EVALUATION.—Section 

17 6071(g) of the Deficit Reduction Act of 2005 (42 

18 U.S.C. 1396a note) is amended— 

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

20 and inserting ‘‘2024’’; and 

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

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

23 after ‘‘2016,’’. 

24 (b) CHANGES TO INSTITUTIONAL RESIDENCY PE25 RIOD REQUIREMENT.— 


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

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

3 note) is amended— 

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

5 ‘‘90’’ and inserting ‘‘60’’; and 

6 (B) by striking the flush sentence after 

7 subparagraph (B). 

8 (2) EFFECTIVE DATE.—The amendments made 

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

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

11 Act. 

12 (c) UPDATES TO STATE APPLICATION REQUIRE13 MENTS.—Section 6071(c) of the Deficit Reduction Act of 

14 2005 (42 U.S.C. 1396a note) is amended— 

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

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

17 (2) in paragraph (7)— 

18 (A) in the paragraph heading, by striking 

19 ‘‘REBALANCING’’ and inserting ‘‘EXPENDI20 TURES’’; 

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

22 at the end; and 

23 (C) in subparagraph (B)— 

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

25 the end; 


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1 (ii) in clause (ii), by striking the pe2 riod at the end and inserting a semicolon; 

3 and 

4 (iii) by adding at the end the fol5 lowing: 

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

7 for each Federal fiscal year that occurs during 

8 the proposed MFP demonstration project— 

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

10 proposed initiative that is designed to ac11 complish the objective described in sub12 section (a)(1), including a funding source 

13 for each activity that is part of each such 

14 proposed initiative; 

15 ‘‘(II) an evaluation plan that identi16 fies expected results for each such pro17 posed initiative; and 

18 ‘‘(III) a sustainability plan for compo19 nents of such proposed initiatives that are 

20 intended to improve transitions, which 

21 shall be updated with actual expenditure 

22 information for each Federal fiscal year 

23 that occurs during the MFP demonstration 

24 project; and 


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1 ‘‘(iv) contain assurances that grant funds 

2 used to accomplish the objective described in 

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

4 than 24 months after the date on which the 

5 funds are awarded and shall be expended not 

6 later than 60 months after the date on which 

7 the funds are awarded (unless the Secretary ap8 proves a waiver of either such requirement).’’; 

9 and 

10 (3) in paragraph (13)— 

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

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

13 will meet the reporting requirements set forth 

14 for the Transformed Medicaid Statistical Man15 agement Information System (T–MSIS);’’; 

16 (B) by redesignating subparagraph (B) as 

17 subparagraph (D); and 

18 (C) by inserting after subparagraph (A) 

19 the following: 

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

21 basis on the use of grant funds by distinct ac22 tivity, as described in the approved work plan, 

23 and by specific population as targeted by the 

24 State; 


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1 ‘‘(C) if the State fails to report the infor2 mation required under subparagraph (B), fails 

3 to report such information on a quarterly basis, 

4 or fails to make progress under the approved 

5 work plan, the State shall implement a correc6 tive action plan and any lack of progress under 

7 the approved work plan may result in with8 holding of grant funds made available to the 

9 State; and’’. 

10 (d) FUNDING FOR QUALITY ASSURANCE AND IM11 PROVEMENT; TECHNICAL ASSISTANCE; OVERSIGHT.— 

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

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

14 and inserting the following: 

15 ‘‘(2) FUNDING.—From the amounts appro16 priated under subsection (h)(1) for each of fiscal 

17 years 2019 through 2024, $1,000,000 shall be avail18 able to the Secretary for each such fiscal year to 

19 carry out this subsection.’’. 

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

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

22 is amended by adding at the end the following: 

23 ‘‘(i) BEST PRACTICES.— 

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

25 through grant or contract, shall submit a report to 


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1 the President and Congress not later than Sep2 tember 30, 2020, that contains findings and conclu3 sions on best practices from the State MFP dem4 onstration projects carried out with grants made 

5 under this section. The report shall include informa6 tion and analyses with respect to the following: 

7 ‘‘(A) The most effective State strategies 

8 for transitioning beneficiaries from institutional 

9 to qualified community settings carried out 

10 under the State MFP demonstration projects 

11 and how such strategies may vary for different 

12 types of beneficiaries, such as beneficiaries who 

13 are aged, physically disabled, intellectually or 

14 developmentally disabled, or individuals with se15 rious mental illnesses, and other targeted waiv16 er beneficiary populations. 

17 ‘‘(B) The most common and the most ef18 fective State uses of grant funds carried out 

19 under the State MFP demonstration projects 

20 for transitioning beneficiaries from institutional 

21 to qualified community settings and improving 

22 health outcomes, including differentiating fund23 ing for current initiatives that are designed for 

24 such purpose and funding for proposed initia25 tives that are designed for such purpose. 


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1 ‘‘(C) The most effective State approaches 

2 carried out under State MFP demonstration 

3 projects for improving person-centered care and 

4 planning. 

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

6 and other flexibilities available under the State 

7 MFP demonstration projects, that are not 

8 available under the traditional Medicaid pro9 gram, and which directly contributed to suc10 cessful transitions and improved health out11 comes under the State MFP demonstration 

12 projects. 

13 ‘‘(E) State strategies and financing mecha14 nisms for effective coordination of housing fi15 nanced or supported under State MFP dem16 onstration projects with local housing authori17 ties and other resources. 

18 ‘‘(F) Effective State approaches for deliv19 ering Money Follows the Person transition serv20 ices through managed care entities. 

21 ‘‘(G) Other best practices and effective 

22 transition strategies demonstrated by States 

23 with approved MFP demonstration projects, as 

24 determined by the Secretary. 


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1 ‘‘(H) Identification and analyses of oppor2 tunities and challenges to integrating effective 

3 Money Follows the Person practices and State 

4 strategies into the traditional Medicaid pro5 gram. 

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

7 required under this subsection, the Secretary shall 

8 collect and incorporate information from States with 

9 approved MFP demonstration projects and bene10 ficiaries participating in such projects, and providers 

11 participating in such projects. 

12 ‘‘(3) FUNDING.—From the amounts appro13 priated under subsection (h)(1) for each of fiscal 

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

15 be available to the Secretary for each such fiscal 

16 year to carry out this subsection.’’. 

17 (f) MACPAC REPORT ON QUALIFIED SETTINGS CRI18 TERIA.—Section 6071 of the Deficit Reduction Act of 

19 2005 (42 U.S.C. 1396a note), as amended by subsection 

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

21 ‘‘(j) MACPAC REPORT.—Prior to the final imple22 mentation date established by the Secretary for the cri23 teria established for home and community-based settings 

24 in section 441.301(c)(4) of title 42, Code of Federal Regu25 lations, as part of final implementation of the Home and 


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1 Community Based Services (HCBS) Final Rule published 

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

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

4 and CHIP Payment and Access Commission (MACPAC) 

5 shall submit to Congress a report that— 

6 ‘‘(1) identifies the types of home and commu7 nity-based settings and associated services that are 

8 available to eligible individuals in both the MFP 

9 demonstration program and sites in compliance with 

10 the HCBS final rule; and 

11 ‘‘(2) if determined appropriate by the Commis12 sion, recommends policies to align the criteria for a 

13 qualified residence under subsection (b)(6) (as in ef14 fect on October 1, 2017) with the criteria in the 

15 HCBS final rule.’’. 

16 (g) APPLICATION TO CURRENT PROJECTS.—Not 

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

18 Act, any State with an approved MFP demonstration 

19 project under section 6071 of the Deficit Reduction Act 

20 of 2005 (42 U.S.C. 1396a note) on the date of the enact21 ment of this Act shall submit a revised application to the 

22 Secretary that contains the same information and assur23 ances as are required for any new State applicant under 

24 the amendments made by this section. 


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1 SEC. 3. CLARIFYING AUTHORITY OF STATE MEDICAID 

2 FRAUD AND ABUSE CONTROL UNITS TO IN3 VESTIGATE AND PROSECUTE CASES OF MED4 ICAID PATIENT ABUSE AND NEGLECT IN ANY 

5 SETTING. 

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

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

8 amended by inserting after ‘‘patients residing in board 

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

10 are receiving medical assistance under the State plan 

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

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

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

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

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

16 elimination of fraud in the provision and administration 

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

18 SEC. 4. EXTENSION OF PROTECTION FOR MEDICAID RE19 CIPIENTS OF HOME AND COMMUNITY-BASED 

20 SERVICES AGAINST SPOUSAL IMPOVERISH21 MENT. 

22 (a) IN GENERAL.—Section 2404 of Public Law 111– 

23 148 (42 U.S.C. 1396r–5 note) is amended by striking 

24 ‘‘September 30, 2019’’ and inserting ‘‘March 31, 2024’’. 

25 (b) RULE OF CONSTRUCTION.—Nothing in section 

26 2404 of Public Law 111–148 (42 U.S.C. 1396r–5 note), 


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1 section 1924 of the Social Security Act (42 U.S.C. 1396r– 

2 5), or section 1902(a)(17) of such Act (42 U.S.C. 

3 1396a(a)(17)) shall be construed as prohibiting a State 

4 from applying an income or resource disregard authorized 

5 under section 1902(r)(2) of such Act (42 U.S.C. 

6 1396a(r)(2))— 

7 (1) to the income or resources of individuals de8 scribed in section 1902(a)(10)(A)(ii)(VI) of such Act 

9 (42 U.S.C. 1396a(a)(10)(A)(ii)(VI)) (including a 

10 disregard of the income or resources of such individ11 ual’s spouse); or 

12 (2) on the basis of an individual’s need for 

13 home and community-based services authorized 

14 under subsection (c), (d), (i), or (k) of section 1915 

15 of such Act (42 U.S.C. 1396n) or under section 

16 1115 of such Act (42 U.S.C. 1315). 

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’’. 

5 SEC. 8. DETERMINATION OF BUDGETARY EFFECTS. 

6 The budgetary effects of this Act, for the purpose of 

7 complying with the Statutory Pay-As-You-Go Act of 2010, 

8 shall be determined by reference to the latest statement 

9 titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 

10 Act, submitted for printing in the Congressional Record 

11 by the Chairman of the House Budget Committee, pro12 vided that such statement has been submitted prior to the 

13 vote on passage. 

Passed the House of Representatives June 18, 2019. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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