I 
117TH CONGRESS 
1ST SESSION H. R. 4406 
To amend titles XI and XIX of the Social Security Act to provide increased 
financial support to the territories under the Medicaid program, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 13, 2021 
Mr. SOTO (for himself, Mr. BILIRAKIS, Mr. SAN NICOLAS, Miss GONZA´LEZ- 
COLO´N, Mrs. RADEWAGEN, Mr. SABLAN, and Ms. PLASKETT) 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 increased financial support to the territories 
under the Medicaid program, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Supporting Medicaid 
in the U.S. Territories Act of 2021’’. 
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SEC. 2. EXTENDING THE INCREASED FEDERAL MEDICAL 
ASSISTANCE 
PERCENTAGE 
AND 
CAP 
AMOUNTS FOR TERRITORIES. 
(a) FEDERAL MEDICAL ASSISTANCE PERCENTAGE 
EXTENSION.— 
(1) IN GENERAL.—Section 1905(ff) of the So-
cial Security Act (42 U.S.C. 1396d(ff)) is amend-
ed— 
(A) in paragraph (2), by striking ‘‘2021’’ 
and inserting ‘‘2026’’; and 
(B) in paragraph (3), by striking ‘‘2021’’ 
and inserting ‘‘2029’’. 
(2) ENSURING PROGRAM INTEGRITY.—Section 
1108(g) of the Social Security Act (42 U.S.C. 
1308(g)) is amended— 
(A) in paragraph (7)(B)(i), in the matter 
preceding subclause (I), by striking ‘‘2021’’ and 
inserting ‘‘2026’’; and 
(B) in paragraph (8)(B), by striking 
‘‘2021’’ and inserting ‘‘2026’’. 
(b) CAP AMOUNT EXTENSION.— 
(1) PUERTO RICO.— 
(A) ENSURING INCREASED CAP AMOUNT IN 
RESPONSE
TO
COVID–19.—Section 1108(g) of 
the Social Security Act (42 U.S.C. 1308(g)) is 
amended— 
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(i) in paragraph (2)(A)(ii), by striking 
‘‘2021’’ and inserting ‘‘2026’’; and 
(ii) in paragraph (6)— 
(I) in the header, by striking 
‘‘2021’’ and inserting ‘‘2026’’; 
(II) in subparagraph (A)— 
(aa) in clause (i), by striking 
‘‘and’’ at the end; and 
(bb) in clause (ii)— 
(AA) by striking ‘‘fiscal 
year 2021’’ and inserting 
‘‘each of fiscal years 2021 
and 2022’’; and 
(BB) by striking the 
period 
and 
inserting 
‘‘; 
and’’; and 
(III) in subparagraph (B)— 
(aa) in clause (i), by striking 
‘‘2021’’ and inserting ‘‘2026’’; 
and 
(bb) in clause (ii)(II), by 
striking ‘‘2021’’ and inserting 
‘‘2026’’. 
(B) EXTENSION
OF
CAP
AMOUNT
FOR 
OTHER YEARS.—Section 1108(g)(6)(A) of the 
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Social Security Act (42 U.S.C. 1308(g)), as 
amended by subparagraph (A), is further 
amended by adding at the end the following 
new clause: 
‘‘(iii) for each of fiscal years 2023 
through 2026, $2,719,072,000.’’. 
(2) OTHER TERRITORIES.— 
(A) ENSURING INCREASED CAP AMOUNTS 
IN
RESPONSE
TO
COVID–19.—Section 
1108(g)(2) of the Social Security Act (42 
U.S.C. 1308(g)(2)) is amended in each of sub-
paragraphs 
(B)(iii), 
(C)(iii), 
(D)(iii), 
and 
(E)(iii), by striking ‘‘fiscal year 2021’’ and in-
serting ‘‘each of fiscal years 2021 and 2022’’. 
(B) EXTENSION
OF
CAP
AMOUNTS
FOR 
OTHER YEARS.—Section 1108(g)(2) of the So-
cial Security Act (42 U.S.C. 1308(g)(2)) is 
amended— 
(i) in subparagraph (B)— 
(I) in clause (i), by striking 
‘‘clause (ii)’’ and inserting ‘‘clauses 
(ii) through (iv)’’; 
(II) in clause (ii), by striking 
‘‘and’’ at the end; 
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(III) in clause (iii), by adding 
‘‘and’’ at the end; and 
(IV) by adding at the end the fol-
lowing new clause: 
‘‘(iv) for each of fiscal years 2023 
through 2029, $126,000,000;’’; 
(ii) in subparagraph (C)— 
(I) in clause (i), by striking 
‘‘clause (ii)’’ and inserting ‘‘clauses 
(ii) through (iv)’’; 
(II) in clause (ii), by striking 
‘‘and’’ at the end; 
(III) in clause (iii), by adding 
‘‘and’’ at the end; and 
(IV) by adding at the end the fol-
lowing new clause: 
‘‘(iv) for each of fiscal years 2023 
through 2029, $127,000,000;’’; 
(iii) in subparagraph (D)— 
(I) in clause (i), by striking 
‘‘clause (ii)’’ and inserting ‘‘clauses 
(ii) through (iv)’’; 
(II) in clause (ii), by striking 
‘‘and’’ at the end; 
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(III) in clause (iii), by adding 
‘‘and’’ at the end; and 
(IV) by adding at the end the fol-
lowing new clause: 
‘‘(iv) for each of fiscal years 2023 
through 2029, $60,000,000; and’’; and 
(iv) in subparagraph (E)— 
(I) in clause (i), by striking 
‘‘clause (ii)’’ and inserting ‘‘clauses 
(ii) through (iv)’’; 
(II) in clause (ii), by striking 
‘‘and’’ at the end; 
(III) in clause (iii), by adding 
‘‘and’’ at the end; and 
(IV) by adding at the end the fol-
lowing new clause: 
‘‘(iv) for each of fiscal years 2023 
through 2029, $84,000,000.’’. 
(3) MODIFICATION OF SPECIAL RULE FOR CAL-
CULATION OF CAP AMOUNTS FOR CERTAIN YEARS.— 
Section 1108(g)(2) of the Social Security Act (42 
U.S.C. 1308(g)(2)) is amended, in the matter fol-
lowing subparagraph (E)— 
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Supporting Medicaid in the U.S. Territories Act of 
2021’’ before the period at the end. 
(e) PUERTO RICO PROGRAM INTEGRITY.—Section 
1108(g)(7)(A) of the Social Security Act (42 U.S.C. 
1308(g)(7)(A)) is amended— 
(1) in clause (iii), in the header, by inserting 
‘‘REPORTING’’ after ‘‘REFORM’’; and 
(2) by adding at the end the following new 
clauses: 
‘‘(v) CORE SET REPORTING COMPLI-
ANCE REPORT.—Not later than October 1, 
2022, Puerto Rico shall submit to the 
Chair and Ranking Member of the Com-
mittee on Energy and Commerce of the 
House of Representatives and the Chair 
and Ranking Member of the Committee on 
Finance of the Senate a report outlining 
steps being taken by Puerto Rico to reach 
compliance with the reporting requirements 
described in section 1139A(a)(4)(B) and 
section 1139B(b)(5)(C) and describing 
what further actions are needed by Puerto 
Rico in order to comply with such require-
ments with respect to annual State reports 
under section 1139A(c) and State reports 
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under section 1139B(d)(1) beginning with 
fiscal year 2024. 
‘‘(vi) CONTRACTING
AND
PROCURE-
MENT OVERSIGHT LEAD REQUIREMENT.— 
‘‘(I) IN
GENERAL.—Not later 
than 6 months after the date of the 
enactment of this clause, the agency 
responsible for the administration of 
Puerto 
Rico’s 
Medicaid 
program 
under title XIX shall designate an of-
ficer (other than the director of such 
agency) to serve as the Contracting 
and Procurement Oversight Lead to 
carry out the duties specified in sub-
clause (II). 
‘‘(II) DUTIES.—Not later than 
60 days after the end of each fiscal 
quarter (beginning with the first fiscal 
quarter beginning on or after the date 
that is 1 year after the date of the en-
actment of this clause), the officer 
designated pursuant to subclause (I) 
shall, with respect to each contract 
described in clause (iii) with an an-
nual value exceeding $150,000 en-
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tered into during such quarter, certify 
to the Secretary either— 
‘‘(aa) that such contract has 
met the procurement standards 
identified under any of sections 
75.327, 75.328, and 75.329 of 
title 45, Code of Federal Regula-
tions (or successor regulations); 
or 
‘‘(bb) that extenuating cir-
cumstances (including a lack of 
multiple entities competing for 
such 
contract) 
prevented 
the 
compliance of such contract with 
such standards. 
‘‘(III) PUBLICATION.—The offi-
cer designated pursuant to subclause 
(I) shall make public each certification 
containing extenuating circumstances 
described in subclause (II)(bb) not 
later than 30 days after such certifi-
cation is made, including a description 
of, and justification of, such extenu-
ating circumstances. 
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‘‘(IV) 
REVIEW
OF
COMPLI-
ANCE.—Not later than 2 years after 
the date of the enactment of this 
clause, the Inspector General of the 
Department of Health and Human 
Services shall submit to Congress a 
report on the compliance of Puerto 
Rico with the provisions of this 
clause.’’. 
Æ 
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