I 

116TH CONGRESS 

1ST SESSION H. R. 3631 

To amend titles XI and XIX of the Social Security Act to provide for 

a temporary increase to the limit on Medicaid payments for territories 

of the United States and the Federal medical assistance percentage 

for such territories under the Medicaid program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 9, 2019 

Mr. SOTO (for himself, Mr. BILIRAKIS, Ms. VELA ́ZQUEZ, Miss GONZA ́LEZCOLO ́N of Puerto Rico, Ms. PLASKETT, Mr. SABLAN, Mrs. RADEWAGEN, 

Mr. SAN NICOLAS, Mr. SERRANO, and Mr. FITZPATRICK) introduced the 

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

A BILL 

To amend titles XI and XIX of the Social Security Act 

to provide for a temporary increase to the limit on Medicaid payments for territories of the United States and 

the Federal medical assistance percentage for such territories under the Medicaid program, 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 ‘‘Territories Health 

5 Care Improvement Act’’. 


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1 SEC. 2. MEDICAID PAYMENTS FOR PUERTO RICO AND THE 

2 OTHER TERRITORIES FOR CERTAIN FISCAL 

3 YEARS. 

4 (a) TREATMENT OF CAP.—Section 1108(g) of the 

5 Social Security Act (42 U.S.C. 1308(g)) is amended— 

6 (1) in paragraph (2)— 

7 (A) in the matter preceding subparagraph 

8 (A), by striking ‘‘subject to and section 

9 1323(a)(2) of the Patient Protection and Af10 fordable Care Act paragraphs (3) and (5)’’ and 

11 inserting ‘‘subject to section 1323(a)(2) of the 

12 Patient Protection and Affordable Care Act and 

13 paragraphs (3) and (5)’’; 

14 (B) in subparagraph (A)— 

15 (i) by striking ‘‘Puerto Rico shall not 

16 exceed the sum of’’ and inserting ‘‘Puerto 

17 Rico shall not exceed— 

18 ‘‘(i) except as provided in clause (ii), 

19 the sum of’’; 

20 (ii) by striking ‘‘$100,000;’’ and in21 serting ‘‘$100,000; and’’; and 

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

24 ‘‘(ii) for each of fiscal years 2020 

25 through 2023, the amount specified in 

26 paragraph (6) for each such fiscal year;’’; 


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1 (C) in subparagraph (B)— 

2 (i) by striking ‘‘the Virgin Islands 

3 shall not exceed the sum of’’ and inserting 

4 ‘‘the Virgin Islands shall not exceed— 

5 ‘‘(i) except as provided in clause (ii), 

6 the sum of’’; 

7 (ii) by striking ‘‘$10,000;’’ and insert8 ing ‘‘$10,000; and’’; and 

9 (iii) by adding at the end the fol10 lowing new clause: 

11 ‘‘(ii) for each of fiscal years 2020 

12 through 2025, $126,000,000;’’; 

13 (D) in subparagraph (C)— 

14 (i) by striking ‘‘Guam shall not exceed 

15 the sum of’’ and inserting ‘‘Guam shall not 

16 exceed— 

17 ‘‘(i) except as provided in clause (ii), 

18 the sum of’’; 

19 (ii) by striking ‘‘$10,000;’’ and insert20 ing ‘‘$10,000; and’’; and 

21 (iii) by adding at the end the fol22 lowing new clause: 

23 ‘‘(ii) for each of fiscal years 2020 

24 through 2025, $127,000,000;’’; 

25 (E) in subparagraph (D)— 


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1 (i) by striking ‘‘the Northern Mariana 

2 Islands shall not exceed the sum of’’ and 

3 inserting ‘‘the Northern Mariana Islands 

4 shall not exceed— 

5 ‘‘(i) except as provided in clause (ii), 

6 the sum of’’; and 

7 (ii) by adding at the end the following 

8 new clause: 

9 ‘‘(ii) for each of fiscal years 2020 

10 through 2025, $60,000,000; and’’; and 

11 (F) in subparagraph (E)— 

12 (i) by striking ‘‘American Samoa shall 

13 not exceed the sum of’’ and inserting 

14 ‘‘American Samoa shall not exceed— 

15 ‘‘(i) except as provided in clause (ii), 

16 the sum of’’; 

17 (ii) by striking ‘‘$10,000.’’ and insert18 ing ‘‘$10,000; and’’; and 

19 (iii) by adding at the end the fol20 lowing new clause: 

21 ‘‘(ii) for each of fiscal years 2020 

22 through 2025, $84,000,000.’’; and 

23 (2) by adding at the end the following new 

24 paragraph: 


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1 ‘‘(6) APPLICATION TO PUERTO RICO FOR FIS2 CAL YEARS 2020 THROUGH 2023.—For purposes of 

3 paragraph (2)(A)(ii), the amount specified in this 

4 paragraph is— 

5 ‘‘(A) for fiscal year 2020, $2,823,188,000; 

6 ‘‘(B) for fiscal year 2021, $2,919,072,000; 

7 ‘‘(C) for fiscal year 2022, $3,012,610,000; 

8 and 

9 ‘‘(D) for fiscal year 2023, 

10 $3,114,331,000.’’. 

11 (b) TREATMENT OF FUNDING UNDER ENHANCED

12 ALLOTMENT PROGRAM.—Section 1935(e) of the Social 

13 Security Act (42 U.S.C. 1396u–5(e)) is amended— 

14 (1) in paragraph (1)(B), by striking ‘‘if the 

15 State’’ and inserting ‘‘subject to paragraph (4), if 

16 the State’’; 

17 (2) by redesignating paragraph (4) as para18 graph (5); and 

19 (3) by inserting after paragraph (3) the fol20 lowing new paragraph: 

21 ‘‘(4) TREATMENT OF FUNDING FOR CERTAIN

22 FISCAL YEARS.— 

23 ‘‘(A) PUERTO RICO.—Notwithstanding 

24 paragraph (1)(B), in the case that Puerto Rico 

25 establishes and submits to the Secretary a plan 


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1 described in paragraph (2) with respect to any 

2 of fiscal years 2020 through 2022, the amount 

3 specified in paragraph (3) for Puerto Rico for 

4 such a year shall be taken into account in ap5 plying subparagraph (A)(ii) of section 

6 1108(g)(2) for such year. 

7 ‘‘(B) OTHER TERRITORIES.—Notwith8 standing paragraph (1)(B), in the case that the 

9 Virgin Islands, Guam, the Northern Mariana 

10 Islands, or American Samoa establishes and 

11 submits to the Secretary a plan described in 

12 paragraph (2) with respect to any of fiscal 

13 years 2020 through 2025, the amount specified 

14 in paragraph (3) for the Virgin Islands, Guam, 

15 the Northern Mariana Islands, or American 

16 Samoa, as the case may be, shall be taken into 

17 account in applying, as applicable, subpara18 graph (B)(ii), (C)(ii), (D)(ii), or (E)(ii) of sec19 tion 1108(g)(2) for such year.’’. 

20 (c) INCREASED FMAP.—Section 1905 of the Social 

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

22 (1) in subsection (b), by striking ‘‘and (aa)’’ 

23 and inserting ‘‘(aa), and (ff)’’; and 

24 (2) by adding at the end the following new sub25 section: 


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1 ‘‘(ff) TEMPORARY INCREASE IN FMAP FOR TERRI2 TORIES FOR CERTAIN FISCAL YEARS.— 

3 ‘‘(1) PUERTO RICO.—Notwithstanding sub4 section (b), the Federal medical assistance percent5 age for Puerto Rico shall be equal to— 

6 ‘‘(A) 83 percent for fiscal years 2020 and 

7 2021; and 

8 ‘‘(B) 76 percent for fiscal years 2022 and 

9 2023. 

10 ‘‘(2) VIRGIN ISLANDS.—Notwithstanding sub11 section (b), the Federal medical assistance percent12 age for the Virgin Islands shall be equal to— 

13 ‘‘(A) 100 percent for fiscal year 2020; 

14 ‘‘(B) 83 percent for fiscal years 2021 

15 through 2024; and 

16 ‘‘(C) 76 percent for fiscal year 2025. 

17 ‘‘(3) OTHER TERRITORIES.—Notwithstanding 

18 subsection (b), the Federal medical assistance per19 centage for Guam, the Northern Mariana Islands, 

20 and American Samoa shall be equal to— 

21 ‘‘(A) 100 percent for fiscal years 2020 and 

22 2021; 

23 ‘‘(B) 83 percent for fiscal years 2022 

24 through 2024; and 

25 ‘‘(C) 76 percent for fiscal year 2025.’’. 


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1 (d) ANNUAL REPORT.—Section 1108(g) of the Social 

2 Security Act (42 U.S.C. 1308(g)), as amended by sub3 section (a), is further amended by adding at the end the 

4 following new paragraph: 

5 ‘‘(7) ANNUAL REPORT.— 

6 ‘‘(A) IN GENERAL.—Not later than the 

7 date that is 30 days after the end of each fiscal 

8 year (beginning with fiscal year 2020 and end9 ing with fiscal year 2025), in the case that a 

10 specified territory receives a Medicaid cap in11 crease, or an increase in the Federal medical 

12 assistance percentage for such territory under 

13 section 1905(ff), for such fiscal year, such terri14 tory shall submit to the Chair and Ranking 

15 Member of the Committee on Energy and Com16 merce of the House of Representatives and the 

17 Chair and Ranking Member of the Committee 

18 on Finance of the Senate a report that de19 scribes how such territory has used such Med20 icaid cap increase, or such increase in the Fed21 eral medical assistance percentage, as applica22 ble, to increase access to health care under the 

23 State Medicaid plan of such territory under title 

24 XIX (or a waiver of such plan). Such report 

25 may include— 


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1 ‘‘(i) the extent to which such territory 

2 has, with respect to such plan (or waiv3 er)— 

4 ‘‘(I) increased payments to health 

5 care providers; 

6 ‘‘(II) increased covered benefits; 

7 ‘‘(III) expanded health care pro8 vider networks; or 

9 ‘‘(IV) improved in any other 

10 manner the carrying out of such plan 

11 (or waiver); and 

12 ‘‘(ii) any other information as deter13 mined necessary by such territory. 

14 ‘‘(B) DEFINITIONS.—In this paragraph: 

15 ‘‘(i) MEDICAID CAP INCREASE.—The 

16 term ‘Medicaid cap increase’ means, with 

17 respect to a specified territory and fiscal 

18 year, any increase in the amounts other19 wise determined under this subsection for 

20 such territory for such fiscal year by rea21 son of the amendments made by section 

22 2(a) of the Territories Health Care Im23 provement Act. 

24 ‘‘(ii) SPECIFIED TERRITORY.—The 

25 term ‘specified territory’ means Puerto 


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1 Rico, the Virgin Islands, Guam, the North2 ern Mariana Islands, and American 

3 Samoa.’’. 

4 SEC. 3. APPLICATION OF CERTAIN REQUIREMENTS UNDER 

5 MEDICAID PROGRAM TO CERTAIN TERRI6 TORIES. 

7 (a) APPLICATION OF PAYMENT ERROR RATE MEAS8 UREMENT REQUIREMENTS TO PUERTO RICO.—Section 

9 1903(u)(4) of the Social Security Act (42 U.S.C. 

10 1396b(u)(4)) is amended— 

11 (1) by striking ‘‘to Puerto Rico, Guam’’ and in12 serting ‘‘to Guam’’; and 

13 (2) by striking ‘‘or American Samoa.’’ and in14 serting ‘‘or American Samoa, or, for fiscal years be15 fore fiscal year 2023, to Puerto Rico.’’. 

16 (b) APPLICATION OF ASSET VERIFICATION PROGRAM

17 REQUIREMENTS TO PUERTO RICO AND VIRGIN IS18 LANDS.—Section 1940(a) of the Social Security Act (42 

19 U.S.C. 1396w(a)) is amended— 

20 (1) in paragraph (3)(A), by adding at the end 

21 the following new clause: 

22 ‘‘(iii) IMPLEMENTATION IN PUERTO

23 RICO AND VIRGIN ISLANDS.—The Sec24 retary shall require Puerto Rico to imple25 ment an asset verification program under 


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1 this subsection by the end of fiscal year 

2 2022 and the Virgin Islands to implement 

3 such a program by the end of fiscal year 

4 2023.’’; and 

5 (2) in paragraph (4)— 

6 (A) in the paragraph heading, by striking 

7 ‘‘EXEMPTION OF TERRITORIES’’ and inserting 

8 ‘‘EXEMPTION OF CERTAIN TERRITORIES’’; and 

9 (B) by striking ‘‘and the District of Co10 lumbia’’ and inserting ‘‘, the District of Colum11 bia, Puerto Rico, and the Virgin Islands’’. 

12 (c) APPLICATION OF CERTAIN DATA REPORTING

13 AND PROGRAM INTEGRITY REQUIREMENTS TO NORTH14 ERN MARIANA ISLANDS, AMERICAN SAMOA, AND GUAM.— 

15 (1) IN GENERAL.—Section 1902 of the Social 

16 Security Act (42 U.S.C. 1396a) is amended by add17 ing at the end the following new subsection: 

18 ‘‘(qq) APPLICATION OF CERTAIN DATA REPORTING

19 AND PROGRAM INTEGRITY REQUIREMENTS TO NORTH20 ERN MARIANA ISLANDS, AMERICAN SAMOA, AND GUAM.— 

21 Not later than October 1, 2023, the Northern Mariana 

22 Islands, American Samoa, and Guam shall— 

23 ‘‘(1) implement methods, satisfactory to the 

24 Secretary, for the collection and reporting of reliable 

25 data to the Transformed Medicaid Statistical InforVerDate Sep 11 2014 23:25 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3631.IH H3631

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1 mation System (T–MSIS) (or a successor system); 

2 and 

3 ‘‘(2) demonstrate progress in establishing a 

4 State medicaid fraud control unit described in sec5 tion 1903(q).’’. 

6 (2) CONFORMING AMENDMENT.—Section 

7 1902(j) of the Social Security Act (42 U.S.C. 

8 1396a(j)) is amended— 

9 (A) by striking ‘‘or the requirement’’ and 

10 inserting ‘‘, the requirement’’; and 

11 (B) by inserting before the period at the 

12 end the following: ‘‘, or the requirements under 

13 subsection (qq) (relating to data reporting and 

14 program integrity)’’. 

Æ 


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