I 

116TH CONGRESS 

1ST SESSION H. R. 4195 

To amend titles XVIII and XIX of the Social Security Act to make premium 

and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United 

States. 

IN THE HOUSE OF REPRESENTATIVES 

AUGUST 20, 2019 

Miss GONZA ́LEZ-COLO ́N of Puerto Rico (for herself and Mr. SOTO) introduced 

the following bill; which was 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 amend titles XVIII and XIX of the Social Security Act 

to make premium and cost-sharing subsidies available 

to low-income Medicare part D beneficiaries who reside 

in Puerto Rico or another territory of the United States. 

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 Medicare 

5 Prescription Drug Assistance Equality Act of 2019’’. 


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1 SEC. 2. EQUAL TREATMENT OF RESIDENTS OF TERRI2 TORIES IN PREMIUM AND COST-SHARING 

3 SUBSIDIES UNDER MEDICARE PRESCRIPTION 

4 DRUG PROGRAM. 

5 (a) MEDICARE ASSISTANCE.—Section 1860D– 

6 14(a)(3) of the Social Security Act (42 U.S.C. 1395w– 

7 114(a)(3)) is amended— 

8 (1) in subparagraph (A), in the matter pre9 ceding clause (i), by striking ‘‘subject to subpara10 graph (F),’’; 

11 (2) in subparagraph (B)(v), in the matter pre12 ceding subclause (I), by striking ‘‘Subject to sub13 paragraph (F), the Secretary’’ and inserting ‘‘The 

14 Secretary’’; 

15 (3) in subparagraph (C), by adding at the end 

16 the following new sentence: ‘‘In the case of an indi17 vidual who is not a resident of the 50 States or the 

18 District of Columbia, the poverty line (as such term 

19 is defined in clause (ii)) that shall apply to such in20 dividual shall be the poverty line for the 48 contig21 uous States and the District of Columbia.’’; and 

22 (4) by striking subparagraph (F). 

23 (b) MEDICAID ASSISTANCE.—Section 1935 of the So24 cial Security Act (42 U.S.C. 1396u–5) is amended— 

25 (1) in subsection (c)(1)(A)— 


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1 (A) by inserting ‘‘(and each other State for 

2 each month beginning with January 2020)’’ 

3 after ‘‘January 2006’’; and 

4 (B) in clause (i), by inserting ‘‘or (2)(B) 

5 (as the case may be)’’ after ‘‘paragraph 

6 (2)(A)’’; 

7 (2) in subsection (c)(2)— 

8 (A) in subparagraph (A)— 

9 (i) by amending the heading to read 

10 as follows: ‘‘COMPUTATION FOR 50 STATES

11 AND THE DISTRICT OF COLUMBIA’’; and 

12 (ii) by striking ‘‘a State described in 

13 paragraph (1)’’ and inserting ‘‘one of the 

14 50 States or the District of Columbia’’; 

15 (B) in subparagraph (B)— 

16 (i) by striking ‘‘subparagraph (A)’’ 

17 and inserting ‘‘subparagraph (A) or (B) 

18 (as the case may be)’’; and 

19 (ii) by redesignating such subpara20 graph as subparagraph (C); and 

21 (C) by inserting after subparagraph (A) 

22 the following new subparagraph: 

23 ‘‘(B) COMPUTATION FOR TERRITORIES.— 

24 The amount computed under this paragraph for 

25 a State not described in subparagraph (A) and 


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1 for a month in a year (beginning with 2020) is 

2 equal to— 

‘‘(i) 1 3 ⁄12 of the product of— 

4 ‘‘(I) the amount determined 

5 under subsection (e) for the State for 

6 2019; and 

7 ‘‘(II) 100 percent minus the 

8 highest possible Federal medical as9 sistance percentage that may be ap10 plied to any of the 50 States for fiscal 

11 year 2018 under section 1905(b)(1); 

12 and 

13 ‘‘(ii) increased for each year (begin14 ning with 2019 up to and including the 

15 year involved) by the applicable growth 

16 factor specified in paragraph (4) for that 

17 year.’’; and 

18 (3) in subsection (e)— 

19 (A) in paragraph (1)— 

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

21 ‘‘of such State; and’’ and inserting ‘‘of 

22 such State for years before 2020;’’; 

23 (ii) in subparagraph (B)— 


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1 (I) by inserting ‘‘for periods be2 fore January 1, 2020’’ after ‘‘(B)’’; 

3 and 

4 (II) by striking the period at the 

5 end and inserting ‘‘; and’’; and 

6 (iii) by adding at the end the fol7 lowing new subparagraph: 

8 ‘‘(C) for the first 3 quarters of fiscal year 

9 2020 and for each subsequent fiscal year, the 

10 amount otherwise applied under section 1108(f) 

11 for the State shall be increased by the amount 

12 specified in paragraph (4)(A) for such period or 

13 fiscal year.’’; 

14 (B) in paragraph (2), by striking ‘‘The 

15 Secretary’’ and inserting ‘‘For periods before 

16 January 2020, the Secretary’’; 

17 (C) in paragraph (3)— 

18 (i) in the heading, by inserting ‘‘BE19 FORE SECOND QUARTER OF FISCAL YEAR

20 2020’’ after ‘‘INCREASED AMOUNT’’; 

21 (ii) in subparagraph (A)— 

22 (I) in the matter before clause 

23 (i), by inserting ‘‘or other fiscal pe24 riod’’ after ‘‘for a year’’; and 


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1 (II) in clause (i), by inserting 

2 ‘‘for such year or period’’ after ‘‘sub3 paragraph (B)’’; and 

4 (iii) in subparagraph (B)— 

5 (I) in clause (ii), by striking ‘‘or’’ 

6 at the end; 

7 (II) in clause (iii), by striking ‘‘a 

8 subsequent year’’ and inserting ‘‘a 

9 subsequent fiscal year (before the sec10 ond quarter of fiscal year 2020)’’; 

11 (III) in clause (iii), by striking 

12 the period at the end and inserting ‘‘; 

13 and’’; and 

14 (IV) by adding at the end the fol15 lowing: 

16 ‘‘(iv) for the first quarter of fiscal 

17 year 2020, is equal to 25 percent of the 

18 aggregate amount specified in this sub19 paragraph for the previous fiscal year in20 creased by the annual percentage increase 

21 specified in section 1860D–2(b)(6) for the 

22 year involved.’’; 

23 (D) by striking paragraph (4); and 

24 (E) by inserting after paragraph (3) the 

25 following new paragraph: 


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1 ‘‘(4) INCREASED AMOUNT BEGINNING WITH

2 SECOND QUARTER OF FISCAL YEAR 2020.— 

3 ‘‘(A) IN GENERAL.—The amount specified 

4 in this paragraph for a State for the last 3 

5 quarters of fiscal year 2020 or for a subsequent 

6 fiscal year is equal to the product of— 

7 ‘‘(i) the aggregate amount specified in 

8 subparagraph (B) for such period or fiscal 

9 year; and 

10 ‘‘(ii) the ratio (as estimated by the 

11 Secretary) of— 

12 ‘‘(I) the number of individuals 

13 who are entitled to benefits under 

14 part A or enrolled under part B and 

15 who reside in the State (as deter16 mined by the Secretary based on the 

17 most recent available data before the 

18 beginning of the period or year); to 

19 ‘‘(II) the sum of such numbers 

20 for all States that are subject to this 

21 subsection. 

22 ‘‘(B) AGGREGATE AMOUNT.—The aggre23 gate amount specified in this subparagraph 

24 for— 


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1 ‘‘(i) the last 3 quarters of fiscal year 

2 2020, is equal to 3 times the amount spec3 ified in paragraph (3)(B)(iv); 

4 ‘‘(ii) fiscal year 2021, is equal to 4 

5 times the amount specified in paragraph 

6 (3)(B)(iv) increased by the same annual 

7 percentage increase as is applied to in8 creases in the amounts applied for the fis9 cal year and State under section 1108(f); 

10 or 

11 ‘‘(iii) a subsequent fiscal year, is equal 

12 to the aggregate amount specified in this 

13 subparagraph for the previous fiscal year 

14 increased by the same annual percentage 

15 increase as is applied for the fiscal year 

16 and State under section 1108(f).’’. 

17 (c) CONFORMING AMENDMENT.—Section 1108(f) of 

18 the Social Security Act (42 U.S.C. 1308(f)) is amended 

19 by striking ‘‘1935(e)(1)(B)’’ and inserting ‘‘1935(e)(1)’’. 

20 (d) EFFECTIVE DATES.—The amendments made by 

21 subsection (a) shall take effect on January 1, 2020, and 

22 the amendments made by subsections (b) and (c) shall 

23 take effect on the date of the enactment of this Act. 

Æ 


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