II 

111TH CONGRESS 

1ST SESSION S. 2833 

To provide adjusted Federal medical assistance percentage rates during a 

transitional assistance period. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 3, 2009 

Mr. REED (for himself, Mr. BROWN, Mr. WHITEHOUSE, Mr. AKAKA, Mr. 

DURBIN, Ms. KLOBUCHAR, and Mr. BEGICH) introduced the following 

bill; which was read twice and referred to the Committee on Finance 

A BILL 

To provide adjusted Federal medical assistance percentage 

rates during a transitional assistance period. 

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 ‘‘Transitional Federal 

5 Medical Assistance Percentage Act’’. 

6 SEC. 2. EXTENSION OF ARRA INCREASE IN FMAP. 

7 Section 5001 of ARRA is amended— 

8 (1) in subsection (a)(3), by striking ‘‘first cal9 endar quarter’’ and inserting ‘‘first 3 calendar quar10 ters’’; 


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1 (2) in subsection (b)(2), by inserting before the 

2 period at the end the following: ‘‘and such para3 graph shall not apply to calendar quarters beginning 

4 on or after October 1, 2010’’; 

5 (3) in subsection (d), by inserting ‘‘ending be6 fore October 1, 2010’’ after ‘‘entire fiscal years’’ and 

7 after ‘‘with respect to fiscal years’’; 

8 (4) in subsection (g)(1), by striking ‘‘September 

9 30, 2011’’ and inserting ‘‘December 31, 2011’’; and 

10 (5) in subsection (h)(3), by striking ‘‘December 

11 31, 2010’’ and inserting ‘‘June 30, 2011’’. 

12 SEC. 3. ARRA TRANSITIONAL ASSISTANCE PERIOD. 

13 For each fiscal quarter occurring during the period 

14 beginning on July 1, 2011, and ending on December 31, 

15 2013 (referred to in this Act as the ‘‘ARRA transitional 

16 assistance period’’), a State’s FMAP shall be equal to the 

17 sum of— 

18 (1) the adjusted base FMAP (as determined 

19 under section 4(a)(1)); 

20 (2) the general FMAP adjustment (as deter21 mined under section 4(a)(2)); and 

22 (3) the unemployment FMAP adjustment (as 

23 determined under section 4(a)(3)). 


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1 SEC. 4. ADJUSTMENTS TO FEDERAL MEDICAL ASSISTANCE 

2 PERCENTAGE. 

3 (a) DETERMINATION OF ADJUSTED FMAP.— 

4 (1) ADJUSTED BASE FMAP.— 

5 (A) IN GENERAL.—Subject to subpara6 graph (B), the adjusted base FMAP is deter7 mined as follows: 

8 (i) For the fourth quarter of fiscal 

9 year 2011, the FMAP that would have ap10 plied to the State under section 5001(a) of 

11 ARRA (assuming that such section ap12 plied) for such fiscal quarter minus 2 per13 centage points. 

14 (ii) For any subsequent fiscal quarter 

15 occurring during the ARRA transitional 

16 assistance period, the FMAP as deter17 mined under this paragraph for the pre18 ceding fiscal quarter minus 2 percentage 

19 points. 

20 (B) ELIMINATION OF NEGATIVE ADJUST21 MENT.—If the adjusted base FMAP applicable 

22 to a State under this paragraph for any fiscal 

23 quarter occurring during the ARRA transitional 

24 assistance period would be less than the FMAP 

25 determined for the State for such quarter withVerDate Nov 24 2008 03:06 Dec 04, 2009 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2833.IS S2833

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1 out regard to this paragraph, this paragraph 

2 shall not apply to such State. 

3 (2) GENERAL FMAP ADJUSTMENT.—The gen4 eral FMAP adjustment shall be equal to the fol5 lowing: 

6 (A) For the fourth quarter of fiscal year 

7 2011, 5.7 percentage points. 

8 (B) For the first quarter of fiscal year 

9 2012, 4.95 percentage points. 

10 (C) For the second quarter of fiscal year 

11 2012, 3.95 percentage points. 

12 (D) For the third quarter of fiscal year 

13 2012, 2.7 percentage points. 

14 (E) For the fourth quarter of fiscal year 

15 2012, 1.2 percentage points. 

16 (F) For any subsequent fiscal quarter oc17 curring during the ARRA transitional assist18 ance period, 0.2 percentage points. 

19 (3) UNEMPLOYMENT FMAP ADJUSTMENT.— 

20 (A) IN GENERAL.—Subject to subpara21 graphs (C) and (D), the unemployment FMAP 

22 adjustment shall be equal to the increase in the 

23 State’s FMAP that would have applied to the 

24 State under section 5001(c) of ARRA (assum25 ing that such section applied) for such fiscal 


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1 quarter minus the applicable reduction amount 

2 (as described under subparagraph (B)). 

3 (B) APPLICABLE REDUCTION AMOUNT.— 

4 For purposes of subparagraph (A), the applica5 ble reduction amount shall be equal to the fol6 lowing: 

7 (i) For the fourth fiscal quarter of fis8 cal year 2011, 0.20 percentage points. 

9 (ii) For any subsequent fiscal quarter 

10 occurring during the ARRA transitional 

11 assistance period, the sum of— 

12 (I) the applicable reduction 

13 amount for the preceding fiscal quar14 ter; and 

15 (II) 0.05 percentage points. 

16 (C) ELIMINATION OF NEGATIVE ADJUST17 MENT.—If the unemployment FMAP adjust18 ment applicable to a State under this paragraph 

19 for any fiscal quarter during the ARRA transi20 tional assistance period would be less than zero, 

21 this paragraph shall not apply to such State. 

22 (D) SPECIAL RULE.— 

23 (i) IN GENERAL.—For purposes of 

24 subparagraph (A), with respect to the com25 putation of the state unemployment inVerDate Nov 24 2008 03:06 Dec 04, 2009 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2833.IS S2833

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1 crease percentage (as described under sec2 tion 5001(c)(4) of ARRA) for the last 2 

3 fiscal quarters of the ARRA transitional 

4 assistance period, the most recent previous 

5 3-consecutive-month period (as described 

6 under section 5001(c)(4)(A)(i) of ARRA) 

7 shall be the 3-consecutive-month period be8 ginning with December 2012, or, if it re9 sults in a higher applicable percent under 

10 section 5001(c)(3) of ARRA, the 3-con11 secutive-month period beginning with Jan12 uary 2013. 

13 (ii) REPEAL OF SPECIAL RULE UNDER

14 ARRA FOR LAST 2 CALENDAR QUARTERS

15 OF THE RECESSION ADJUSTMENT PE16 RIOD.—Section 5001(c)(4) of ARRA is 

17 amended by striking subparagraph (C) and 

18 inserting the following: 

19 ‘‘(C) SPECIAL RULE.—With respect to the 

20 first 2 calendar quarters of the recession ad21 justment period, the most recent previous 3- 

22 consecutive-month period described in subpara23 graph (A)(i) shall be the 3-consecutive-month 

24 period beginning with October 2008.’’. 


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1 (b) SCOPE OF APPLICATION.—The adjustments in 

2 the FMAP for a State under this section shall apply for 

3 purposes of title XIX of the Social Security Act and shall 

4 not apply with respect to— 

5 (1) disproportionate share hospital payments 

6 described in section 1923 of such Act (42 U.S.C. 

7 1396r–4); 

8 (2) payments under title IV of such Act (42 

9 U.S.C. 601 et seq.) (except that the increases under 

10 paragraphs (1) and (2) of subsection (a) shall apply 

11 to payments under part E of title IV of such Act (42 

12 U.S.C. 670 et seq.) and, for purposes of the applica13 tion of this section to the District of Columbia, pay14 ments under such part shall be deemed to be made 

15 on the basis of the FMAP applied with respect to 

16 such District for purposes of title XIX and as in17 creased under subsection (a)(2)); 

18 (3) any payments under title XXI of such Act 

19 (42 U.S.C. 1397aa et seq.); 

20 (4) any payments under title XIX of such Act 

21 that are based on the enhanced FMAP described in 

22 section 2105(b) of such Act (42 U.S.C. 1397ee(b)); 

23 or 

24 (5) any payments under title XIX of such Act 

25 that are attributable to expenditures for medical asVerDate Nov 24 2008 03:06 Dec 04, 2009 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2833.IS S2833

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1 sistance provided to individuals made eligible under 

2 a State plan under title XIX of the Social Security 

3 Act (including under any waiver under such title or 

4 under section 1115 of such Act (42 U.S.C. 1315)) 

5 because of income standards (expressed as a per6 centage of the poverty line) for eligibility for medical 

7 assistance that are higher than the income stand8 ards (as so expressed) for such eligibility as in effect 

9 on July 1, 2008, (including as such standards were 

10 proposed to be in effect under a State law enacted 

11 but not effective as of such date or a State plan 

12 amendment or waiver request under title XIX of 

13 such Act that was pending approval on such date). 

14 (c) STATE INELIGIBILITY; LIMITATION; SPECIAL

15 RULES.— 

16 (1) MAINTENANCE OF ELIGIBILITY REQUIRE17 MENTS.— 

18 (A) IN GENERAL.—Subject to subpara19 graph (B) and (C), a State is not eligible for 

20 an increase in its FMAP under subsection (a) 

21 if eligibility standards, methodologies, or proce22 dures under its State plan under title XIX of 

23 the Social Security Act (including any waiver 

24 under such title or under section 1115 of such 

25 Act (42 U.S.C. 1315)) are more restrictive than 


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1 the eligibility standards, methodologies, or pro2 cedures, respectively, under such plan (or waiv3 er) as in effect on July 1, 2008. 

4 (B) STATE REINSTATEMENT OF ELIGI5 BILITY PERMITTED.—Subject to subparagraph 

6 (C), a State that has restricted eligibility stand7 ards, methodologies, or procedures under its 

8 State plan under title XIX of the Social Secu9 rity Act (including any waiver under such title 

10 or under section 1115 of such Act (42 U.S.C. 

11 1315)) after July 1, 2008, is no longer ineli12 gible under subparagraph (A) beginning with 

13 the first calendar quarter in which the State 

14 has reinstated eligibility standards, methodolo15 gies, or procedures that are no more restrictive 

16 than the eligibility standards, methodologies, or 

17 procedures, respectively, under such plan (or 

18 waiver) as in effect on July 1, 2008. 

19 (C) SPECIAL RULES.—A State shall not be 

20 ineligible under subparagraph (A)— 

21 (i) for the fiscal quarters before Octo22 ber 1, 2011, on the basis of a restriction 

23 that was applied after July 1, 2008, and 

24 before the date of the enactment of this 

25 Act, if the State prior to October 1, 2011, 


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1 has reinstated eligibility standards, meth2 odologies, or procedures that are no more 

3 restrictive than the eligibility standards, 

4 methodologies, or procedures, respectively, 

5 under such plan (or waiver) as in effect on 

6 July 1, 2008; or 

7 (ii) on the basis of a restriction that 

8 was directed to be made under State law 

9 as in effect on July 1, 2008, and would 

10 have been in effect as of such date, but for 

11 a delay in the effective date of a waiver 

12 under section 1115 of such Act with re13 spect to such restriction. 

14 (2) COMPLIANCE WITH PROMPT PAY REQUIRE15 MENTS.— 

16 (A) APPLICATION TO PRACTITIONERS.— 

17 (i) IN GENERAL.—Subject to the suc18 ceeding provisions of this subparagraph, no 

19 State shall be eligible for an increased 

20 FMAP rate as provided under this section 

21 for any claim received by a State from a 

22 practitioner subject to the terms of section 

23 1902(a)(37)(A) of the Social Security Act 

24 (42 U.S.C. 1396a(a)(37)(A)) for such days 

25 during any period in which that State has 


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1 failed to pay claims in accordance with 

2 such section as applied under title XIX of 

3 such Act. 

4 (ii) REPORTING REQUIREMENT.— 

5 Each State shall report to the Secretary, 

6 on a quarterly basis, its compliance with 

7 the requirements of clause (i) as such re8 quirements pertain to claims made for cov9 ered services during each month of the 

10 preceding quarter. 

11 (iii) WAIVER AUTHORITY.—The Sec12 retary may waive the application of clause 

13 (i) to a State, or the reporting requirement 

14 imposed under clause (ii), during any pe15 riod in which there are exigent cir16 cumstances, including natural disasters, 

17 that prevent the timely processing of 

18 claims or the submission of such a report. 

19 (iv) APPLICATION TO CLAIMS.— 

20 Clauses (i) and (ii) shall only apply to 

21 claims made for covered services after the 

22 date of enactment of this Act. 

23 (B) APPLICATION TO NURSING FACILITIES

24 AND HOSPITALS.—The provisions of subpara25 graph (A) shall apply with respect to a nursing 


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1 facility or hospital, insofar as it is paid under 

2 title XIX of the Social Security Act on the basis 

3 of submission of claims, in the same or similar 

4 manner (but within the same timeframe) as 

5 such provisions apply to practitioners described 

6 in such subparagraph. 

7 (3) STATE’S APPLICATION TOWARD RAINY DAY

8 FUND.—A State is not eligible for an increase in its 

9 FMAP under paragraphs (2) or (3) of subsection (a) 

10 if any amounts attributable (directly or indirectly) to 

11 such increase are deposited or credited into any re12 serve or rainy day fund of the State. 

13 (4) NO WAIVER AUTHORITY.—Except as pro14 vided in paragraph (2)(A)(iii), the Secretary may 

15 not waive the application of this subsection or sub16 section (d) under section 1115 of the Social Security 

17 Act or otherwise. 

18 (5) LIMITATION OF FMAP TO 100 PERCENT.—In 

19 no case shall an increase in FMAP under this sec20 tion result in an FMAP that exceeds 100 percent. 

21 (d) REQUIREMENTS.— 

22 (1) STATE REPORTS.—Each State that is paid 

23 additional Federal funds as a result of this section 

24 shall, not later than September 30, 2014, submit a 

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1 ner as the Secretary shall determine, regarding how 

2 the additional Federal funds were expended. 

3 (2) ADDITIONAL REQUIREMENT FOR CERTAIN

4 STATES.—In the case of a State that requires polit5 ical subdivisions within the State to contribute to6 ward the non-Federal share of expenditures under 

7 the State Medicaid plan required under section 

8 1902(a)(2) of the Social Security Act (42 U.S.C. 

9 1396a(a)(2)), the State is not eligible for an in10 crease in its FMAP under paragraphs (2) or (3) of 

11 subsection (a) if it requires that such political sub12 divisions pay for quarters during the ARRA transi13 tional assistance period a greater percentage of the 

14 non-Federal share of such expenditures, or a greater 

15 percentage of the non-Federal share of payments 

16 under section 1923, than the respective percentage 

17 that would have been required by the State under 

18 such plan on September 30, 2008, prior to applica19 tion of this section. 

20 (e) DEFINITIONS.—In this Act, except as otherwise 

21 provided: 

22 (1) ARRA.—The term ‘‘ARRA’’ means the 

23 American Recovery and Reinvestment Act of 2009 

24 (Public Law 111–5; 123 Stat. 140). 


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1 (2) FMAP.—The term ‘‘FMAP’ ’’ means the 

2 Federal medical assistance percentage, as defined in 

3 section 1905(b) of the Social Security Act (42 

4 U.S.C. 1396d(b)), as determined without regard to 

5 this section except as otherwise specified. 

6 (3) POVERTY LINE.—The term ‘‘poverty line’’ 

7 has the meaning given such term in section 673(2) 

8 of the Community Services Block Grant Act (42 

9 U.S.C. 9902(2)), including any revision required by 

10 such section. 

11 (4) SECRETARY.—The term ‘‘Secretary’’ means 

12 the Secretary of Health and Human Services. 

13 (5) STATE.—The term ‘‘State’’ has the mean14 ing given such term in section 1101(a)(1) of the So15 cial Security Act (42 U.S.C. 1301(a)(1)) for pur16 poses of title XIX of the Social Security Act (42 

17 U.S.C. 1396 et seq.). 

18 (f) SUNSET.—This section shall not apply to items 

19 and services furnished after the end of the ARRA transi20 tional assistance period. 

Æ 


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