I 
117TH CONGRESS 
1ST SESSION H. R. 1722 
To amend titles XI and XIX of the Social Security Act to stabilize the 
Medicaid program in Puerto Rico. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 9, 2021 
Ms. VELA´ZQUEZ (for herself, Mr. ESPAILLAT, Ms. OCASIO-CORTEZ, Mr. 
GARCI´A of Illinois, Mr. GRIJALVA, and Miss GONZA´LEZ-COLO´N) intro-
duced 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 stabilize the Medicaid program in Puerto Rico. 
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 ‘‘Puerto Rico Health 
Care Fairness, Accountability, and Beneficiary Access Act 
of 2021’’. 
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SEC. 2. ADJUSTMENTS TO FMAP AND CAP FOR PUERTO 
RICO. 
(a) ADJUSTMENTS TO FMAP.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (b) by inserting ‘‘(except for 
Puerto Rico, for calendar quarters in a fiscal year 
beginning with fiscal year 2022, shall be the PR 
specified percent under subsection (hh) for such fis-
cal year)’’ after ‘‘shall be 55 percent’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(hh) PR SPECIFIED PERCENT.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(b), the PR specified percent under this subsection 
is— 
‘‘(A) subject to paragraph (2), for each of 
fiscal years 2022 through 2026, 83 percent; 
‘‘(B) subject to paragraph (3)(D)(iii), for 
each of fiscal years 2027 through 2031, 83 per-
cent; and 
‘‘(C) subject to paragraph (3)(D)(iii), for 
fiscal year 2032 and each subsequent fiscal 
year, the Federal medical assistance percentage 
calculated in accordance with the first sentence 
of subsection (b), as such sentence applies to 
the 50 States. 
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‘‘(2) PROGRAM ENHANCEMENT INCENTIVES.— 
‘‘(A) IN GENERAL.—If Puerto Rico— 
‘‘(i) for fiscal year 2023, is in compliance 
with none of the program enhancement require-
ments described in subparagraph (B), the PR 
specified percent specified under paragraph (1) 
for such fiscal year shall be reduced by 2 per-
cent; 
‘‘(ii) for fiscal year 2024, is in compliance 
with fewer than two of the four program en-
hancement requirements described in subpara-
graph (B), the PR specified percent specified 
under paragraph (1) for such fiscal year shall 
be reduced by 3 percent; 
‘‘(iii) for fiscal year 2025, is in compliance 
with fewer than three of the four program en-
hancement requirements described in subpara-
graph (B), the PR specified percent specified 
under paragraph (1) for such fiscal year shall 
be reduced by 5 percent; and 
‘‘(iv) for fiscal year 2026, is in compliance 
with fewer than four of the program enhance-
ment requirements described in subparagraph 
(B), the PR specified percent specified under 
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paragraph (1) for such fiscal year shall be re-
duced by 5 percent. 
‘‘(B) 
PROGRAM
ENHANCEMENT
REQUIRE-
MENTS.—For purposes of this subsection, the pro-
gram enhancement requirements described in this 
subparagraph are each of the following: 
‘‘(i) Rates of payment under the State 
plan under this title for inpatient hospital serv-
ices are not less than the costs incurred for 
such services. 
‘‘(ii) Rates of payment under the State 
plan under this title for physicians’ services are 
not less than 70 percent of the amount that is 
payable for such services under section 1848. 
‘‘(iii) The State plan provides for medical 
assistance for Hepatitis C drugs, in accordance 
with the requirements of section 1927 otherwise 
applicable to the 50 States. 
‘‘(iv) The State plan provides for medical 
assistance for Medicare cost-sharing described 
in subsection (p)(3)(A)(ii) for qualified Medi-
care beneficiaries described in subsection (p)(1), 
in accordance with the requirements under sub-
section (p) otherwise applicable to the 50 
States. 
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‘‘(3) TERRITORY TRANSITION PLAN.— 
‘‘(A) IN GENERAL.— 
‘‘(i) SUBMISSION
OF
PLAN.—Not later 
than January 1, 2024, the Governor of Puerto 
Rico shall submit to the Secretary a Territory 
Transition Plan, which shall be developed with 
stakeholder input and with a public comment 
period, that includes— 
‘‘(I) a detailed description of which 
program enhancements described in sub-
paragraph (C) Puerto Rico will include as 
medical assistance under the State plan 
under title XIX, the first plan year by 
which each such program enhancement will 
be so included in order to satisfy the re-
quirements described in subparagraph (B), 
and a timeline for milestones for including 
such program enhancements; and 
‘‘(II) a description of any challenges, 
including infrastructure challenges, pro-
vider shortages, and financing challenges, 
for so including such program enhance-
ments and a plan to ameliorate any such 
challenges. 
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‘‘(ii) NOTIFICATION OF PLAN APPROVAL.— 
The plan submitted under clause (i) shall be 
treated as approved by the Secretary not later 
than 180 days after the date of submission of 
the plan unless within such 180-day period the 
Secretary disapproves such plan and notifies 
Puerto Rico of such disapproval with the reason 
for such disapproval. In the case of such a dis-
approval, the Governor of Puerto Rico shall, 
within the 90-day period following such notifi-
cation, submit to the Secretary a Territory 
Transition Plan that addresses the reason spec-
ified in such notification for such disapproval. 
Such resubmitted plan shall be treated as ap-
proved by the Secretary under this clause un-
less the Secretary notifies Puerto Rico within 
the 30-day period following such submission of 
its disapproval with a reason for such dis-
approval. The Governor of Puerto Rico may de-
velop and submit to the Secretary, in the same 
manner and subject to the same conditions as 
apply under clause (i) to the development and 
submission of the Territory Transition Plan, 
modifications to the plan and such modifica-
tions shall be treated as approved by the Sec-
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Rico is not in compliance with the timeline or 
with achieving milestones as described in sub-
clause (I) (or, with respect to a fiscal year after 
fiscal year 2028, not in compliance with the ap-
plicable requirement under subparagraph (B)), 
not later than 90 days after the date of such 
finding, Puerto Rico shall submit to the Sec-
retary for approval a corrective action plan to 
remedy such noncompliance. 
‘‘(iii) If, by not later than a period speci-
fied by the Secretary after the date of the sub-
mission (and approval) of a corrective action 
plan under clause (ii), with respect to a fiscal 
year after fiscal year 2026 for which a finding 
of non-compliance was made under clause (i), 
the Secretary determines that Puerto Rico has 
not fulfilled the terms of such corrective action 
plan, the PR specified percent specified under 
paragraph (1) for the fiscal year involved shall 
be reduced by 5 percent for the period begin-
ning with the month beginning after such deter-
mination and ending with the first month be-
ginning after the Secretary determines Puerto 
Rico has fulfilled the terms of the corrective ac-
tion plan.’’. 
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(b) TREATMENT OF CAP.—Section 1108(g) of the 
Social Security Act (42 U.S.C. 1308(g)) is amended— 
(1) in paragraph (2)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘subject to and section 
1323(a)(2) of the Patient Protection and Af-
fordable Care Act paragraphs (3) and (5)’’ and 
inserting ‘‘subject to section 1323(a)(2) of the 
Patient Protection and Affordable Care Act and 
paragraphs (3), (5), and (7)’’; and 
(B) in subparagraph (A)— 
(i) by striking ‘‘Puerto Rico shall not 
exceed the sum of’’ and inserting ‘‘Puerto 
Rico shall not exceed— 
‘‘(i) in the case of a fiscal year before 
fiscal year 2022, the sum of’’; 
(ii) by striking ‘‘$100,000;’’ and in-
serting ‘‘$100,000; and’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(ii) in the case of fiscal year 2022 
and each subsequent fiscal year (before fis-
cal year 2027), the amount specified in 
paragraph (6) for such fiscal year;’’; and 
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(2) by adding at the end the following new 
paragraphs: 
‘‘(6) APPLICATION TO PUERTO RICO FOR FIS-
CAL YEARS 2022 THROUGH 2026.—For purposes of 
paragraph (2)(A)(ii), the amount specified in this 
paragraph is— 
‘‘(A) for fiscal year 2022, $3,012,610,000; 
‘‘(B) for fiscal year 2023, $3,114,331,000; 
‘‘(C) for fiscal year 2024, $3,225,627,000; 
‘‘(D) for fiscal year 2025, $3,336,627,000; 
and 
‘‘(E) for fiscal year 2026, $3,447,627,000. 
‘‘(7) PUERTO RICO EXCLUSION FROM PAYMENT 
LIMITATION BEGINNING FISCAL YEAR 2027.—Begin-
ning with fiscal year 2027, there shall be no limita-
tion applied under this subsection (f) or this sub-
section on the total amount certified by the Sec-
retary under title XIX for payment to Puerto 
Rico.’’. 
(c) TEMPORARY INCREASE IN FEDERAL MATCH FOR 
STATE
PLAN
ADMINISTRATIVE
COSTS.—Section 
1903(a)(7) of the Social Security Act (42 U.S.C. 
1396b(a)(7)) is amended by inserting ‘‘(or, in the case of 
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Puerto Rico for each of fiscal years 2022 through 2035, 
100 percent)’’ after ‘‘50 per centum’’. 
Æ 
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