I 
113TH CONGRESS 
2D SESSION 
H. R. 3966 
To amend titles XVIII and XIX of the Social Security Act to provide for 
equitable treatment of residents of the territories with respect to low- 
income subsidies under the Medicare prescription drug benefit program, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 29, 2014 
Mr. PIERLUISI
(for himself, Mrs. CHRISTENSEN, Ms. BORDALLO, Mr. 
SABLAN, Mr. FALEOMAVAEGA, Mr. GRAYSON, and Mr. RANGEL) intro-
duced 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 provide for equitable treatment of residents of the 
territories with respect to low-income subsidies under 
the Medicare prescription drug benefit 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 ‘‘Territories Medicare 
Prescription Drug Assistance Equity Act of 2014’’. 
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SEC. 2. EQUITABLE TREATMENT OF RESIDENTS OF TERRI-
TORIES IN PREMIUM AND COST-SHARING 
SUBSIDIES UNDER MEDICARE PRESCRIPTION 
DRUG PROGRAM. 
(a) 
MEDICARE
ASSISTANCE.—Section 
1860D– 
14(a)(3) of the Social Security Act (42 U.S.C. 1395w– 
114(a)(3)) is amended by striking subparagraph (F). 
(b) MEDICAID ASSISTANCE.—Section 1935 of the So-
cial Security Act (42 U.S.C. 1396v) is amended— 
(1) in subsection (c)(1)(A)— 
(A) by inserting ‘‘(and each other State for 
each month beginning with January 2016)’’ 
after ‘‘January 2006’’; and 
(B) in clause (i), by inserting ‘‘or (2)(B) 
(as the case may be)’’ after ‘‘paragraph 
(2)(A)’’; 
(2) in subsection (c)(2)— 
(A) in subparagraph (A)— 
(i) by amending the heading to read 
as follows: ‘‘COMPUTATION FOR 50 STATES 
AND THE DISTRICT OF COLUMBIA’’; and 
(ii) by striking ‘‘a State described in 
paragraph (1)’’ and inserting ‘‘one of the 
50 States or the District of Columbia’’; 
(B) in subparagraph (B)— 
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(i) by striking ‘‘subparagraph (A)’’ 
and inserting ‘‘subparagraph (A) or (B) 
(as the case may be)’’; and 
(ii) by redesignating such subpara-
graph as subparagraph (C); and 
(C) by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) COMPUTATION FOR TERRITORIES.— 
The amount computed under this paragraph for 
a State not described in subparagraph (A) and 
for a month in a year (beginning with 2016) is 
equal to— 
‘‘(i) 1⁄12 of the product of— 
‘‘(I) 
the 
amount 
determined 
under subsection (e) for the State for 
2015; and 
‘‘(II) 100 percent minus the 
highest possible Federal medical as-
sistance percentage that may be ap-
plied to any of the 50 States for fiscal 
year 2014 under section 1905(b)(1); 
and 
‘‘(ii) increased for each year ((begin-
ning with 2016) up to and including the 
year involved) by the applicable growth 
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factor specified in paragraph (4) for that 
year.’’; and 
(3) in subsection (e)— 
(A) in paragraph (1)— 
(i) in subparagraph (A), by striking 
‘‘of such State; and’’ and inserting ‘‘of 
such State for years before 2016;’’; 
(ii) in subparagraph (B)— 
(I) by inserting ‘‘for periods be-
fore January 1, 2016’’ after ‘‘(B)’’; 
and 
(II) by striking the period at the 
end and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) for the first 3 quarters of fiscal year 
2016 and for each subsequent fiscal year, the 
amount otherwise applied under section 1108(f) 
for the State shall be increased by the amount 
specified in paragraph (4)(A) for such period or 
fiscal year.’’; 
(B) in paragraph (2), by striking ‘‘The 
Secretary’’ and inserting ‘‘For periods before 
January 2016, the Secretary’’; 
(C) in paragraph (3)— 
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(i) in the heading, by inserting ‘‘BE-
FORE SECOND QUARTER OF FISCAL YEAR 
2016’’ after ‘‘INCREASED AMOUNT’’; 
(ii) in subparagraph (A)— 
(I) in the matter before clause 
(i), by inserting ‘‘or other fiscal pe-
riod’’ after ‘‘for a year’’; and 
(II) in clause (i), by inserting 
‘‘for such year or period’’ after ‘‘sub-
paragraph (B)’’; and 
(iii) in subparagraph (B)— 
(I) in clause (ii), by striking ‘‘or’’ 
at the end; 
(II) in clause (iii), by striking ‘‘in 
a subsequent year’’ and inserting ‘‘in 
a subsequent fiscal year (before the 
second quarter of fiscal year 2016)’’ 
and by striking the period at the end 
and inserting ‘‘; and’’; and 
(III) by adding at the end the 
following: 
‘‘(iv) for the first quarter of fiscal 
year 2016, is equal to 25 percent of the 
aggregate amount specified in this sub-
paragraph for the previous fiscal year in-
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creased by the annual percentage increase 
specified in section 1860D–2(b)(6) for the 
year involved.’’; 
(D) by striking paragraph (4); and 
(E) by inserting after paragraph (3) the 
following new paragraph: 
‘‘(4) INCREASED
AMOUNT
BEGINNING
WITH 
SECOND QUARTER OF FISCAL YEAR 2016.— 
‘‘(A) IN GENERAL.—The amount specified 
in this paragraph for a State for the last 3 
quarters of fiscal year 2016 or for a subsequent 
fiscal year is equal to the product of— 
‘‘(i) the aggregate amount specified in 
subparagraph (B) for such period or fiscal 
year; and 
‘‘(ii) the ratio (as estimated by the 
Secretary) of— 
‘‘(I) the number of individuals 
who are entitled to benefits under 
part A or enrolled under part B and 
who reside in the State (as deter-
mined by the Secretary based on the 
most recent available data before the 
beginning of the period or year); to 
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‘‘(II) the sum of such numbers 
for all States that are subject to this 
subsection. 
‘‘(B) AGGREGATE
AMOUNT.—The aggre-
gate amount specified in this subparagraph 
for— 
‘‘(i) the last 3 quarters of fiscal year 
2016, is equal to 3 times the amount spec-
ified in paragraph (3)(B)(iv); 
‘‘(ii) fiscal year 2017, is equal to 4 
times the amount specified in paragraph 
(3)(B)(iv) increased by the same annual 
percentage increase as is applied to in-
creases in the amounts applied for the fis-
cal year and State under section 1108(f); 
or 
‘‘(iii) a subsequent fiscal year, is equal 
to the aggregate amount specified in this 
subparagraph for the previous fiscal year 
increased by the same annual percentage 
increase as is applied for the fiscal year 
and State under section 1108(f).’’. 
(c) CONFORMING AMENDMENTS.— 
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(1) Section 1108(f) of the Social Security Act 
(42 U.S.C. 1308(f)) is amended by striking 
‘‘1935(e)(1)(B)’’ and inserting ‘‘1935(e)(1)’’. 
(2) Section 1860D–14(a)(3)(C) of the Social 
Security Act (42 U.S.C. 1395w–114(a)(3)(C)) is 
amended by adding at the end the following: ‘‘The 
poverty line to be applied in the territories shall be 
the same as the poverty line applied to States in the 
continental United States.’’. 
(d) EFFECTIVE DATES.—The amendments made by 
subsections (a) and (c)(2) shall be effective as of January 
1, 2016, and the amendments made by subsections (b) and 
(c)(1) shall take effect on the date of the enactment of 
this Act. 
Æ 
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