months beginning on or after the date of the enactment 
of this Act. 
Subtitle C—Medicare Advantage 
(Part C) 
SEC. 221. ADJUSTMENT IN BENCHMARK FOR LOW-BASE 
PAYMENT COUNTIES IN PUERTO RICO. 
Section 1853(n) of the Social Security Act (42 U.S.C. 
1395w–23(n)) is amended— 
(1) in paragraph (1), by striking ‘‘and (5)’’ and 
inserting ‘‘(5), and (6)’’; 
(2) in paragraph (4), by striking ‘‘In no case’’ 
and inserting ‘‘Subject to paragraph (6), in no 
case’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(6) SPECIAL
RULES
FOR
BLENDED
BENCH-
MARK AMOUNT FOR TERRITORIES.— 
‘‘(A) IN GENERAL.—Subject to paragraph 
(2), the blended benchmark amount for an area 
in a territory for a year (beginning with 2024) 
shall not be less than 80 percent of the national 
average of the base payment amounts specified 
in subparagraph (2)(E) for such year for areas 
within the 50 States and the District of Colum-
bia. 
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‘‘(B) LIMITATION.—In no case shall the 
blended benchmark amount for an area in a 
territory for a year under subparagraph (A) ex-
ceed the lowest blended benchmark amount for 
any area within the 50 States and the District 
of Columbia for such year.’’. 
Subtitle D—Part D 
SEC. 231. AUTOMATIC ELIGIBILITY OF CERTAIN LOW-IN-
COME TERRITORIAL RESIDENTS FOR PRE-
MIUM AND COST-SHARING SUBSIDIES UNDER 
THE MEDICARE PROGRAM; SUNSET OF EN-
HANCED ALLOTMENT PROGRAM. 
(a) AUTOMATIC ELIGIBILITY OF CERTAIN LOW-IN-
COME TERRITORIAL RESIDENTS
FOR PREMIUM
AND 
COST-SHARING SUBSIDIES UNDER THE MEDICARE PRO-
GRAM.— 
(1) IN GENERAL.—Section 1860D–14(a)(3) of 
the Social Security Act (42 U.S.C. 1395w– 
114(a)(3)) is amended— 
(A) in subparagraph (B)(v)— 
(i) in subclause (I), by striking ‘‘and’’ 
at the end; 
(ii) in subclause (II), by striking the 
period and inserting ‘‘; and’’; and 
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(iii) by inserting after subclause (II) 
the following new subclause: 
‘‘(III) with respect to plan years 
beginning on or after January 1, 
2024, shall provide that any part D 
eligible individual who is enrolled for 
medical assistance under the State 
Medicaid plan of a territory (as de-
fined in section 1935(f)) under title 
XIX (or a waiver of such a plan) shall 
be treated as a subsidy eligible indi-
vidual described in paragraph (1).’’; 
and 
(B) in subparagraph (F), by adding at the 
end the following new sentence: ‘‘The previous 
sentence shall not apply with respect to eligi-
bility determinations for premium and cost- 
sharing subsidies under this section made on or 
after January 1, 2024.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1860D–31(j)(2)(D) of the Social Security Act (42 
U.S.C. 1395w–141(j)(2)(D)) is amended by adding 
at the end the following new sentence: ‘‘The previous 
sentence shall not apply with respect to amounts 
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made available to a State under this paragraph on 
or after January 1, 2024.’’. 
(b) SUNSET
OF
ENHANCED
ALLOTMENT
PRO-
GRAM.— 
(1) IN GENERAL.—Section 1935(e) of the So-
cial Security Act (42 U.S.C. 1396u–5(e)) is amend-
ed— 
(A) in paragraph (1)(A), by inserting after 
‘‘such State’’ the following: ‘‘before January 1, 
2024’’; and 
(B) in paragraph (3)— 
(i) in subparagraph (A), in the matter 
preceding clause (i), by inserting after ‘‘a 
year’’ the following: ‘‘(before 2024)’’; and 
(ii) in subparagraph (B)(iii), by strik-
ing ‘‘a subsequent year’’ and inserting 
‘‘each of fiscal years 2008 through 2023’’. 
(2) TERRITORY DEFINED.—Section 1935 of the 
Social Security Act (42 U.S.C. 1396u–5) is amended 
by adding at the end the following new subsection: 
‘‘(f) TERRITORY DEFINED.—In this section, the term 
‘territory’ means Puerto Rico, the Virgin Islands, Guam, 
the Northern Mariana Islands, and American Samoa.’’. 
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TITLE III—MISCELLANEOUS 
SEC. 301. MEDICAID AND CHIP TERRITORY TRANSPARENCY 
AND INFORMATION. 
(a) PUBLICATION OF INFORMATION ON FEDERAL 
EXPENDITURES UNDER MEDICAID AND CHIP IN THE 
TERRITORIES.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services shall publish, and periodically update, on 
the internet site of the Centers for Medicare & Medicaid 
Services information on Medicaid and CHIP carried out 
in the territories of the United States. Such information 
shall include, with respect to each such territory— 
(1) the income levels established by the terri-
tory for purposes of eligibility of an individual to re-
ceive medical assistance under Medicaid or child 
health assistance under CHIP; 
(2) the number of individuals enrolled in Med-
icaid and CHIP in such territory; 
(3) any State plan amendments in effect to 
carry out Medicaid or CHIP in such territory; 
(4) any waiver of the requirements of title XIX 
or title XXI issued by the Secretary to carry out 
Medicaid or CHIP in the territory, including a waiv-
er under section 1115 of the Social Security Act (42 
U.S.C. 1315), any application for such a waiver, and 
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any documentation related to such application (in-
cluding correspondence); 
(5) the amount of the Federal and non-Federal 
share of expenditures under Medicaid and CHIP in 
such territory; 
(6) the systems in place for the furnishing of 
health care items and services under Medicaid and 
CHIP in such territory; 
(7) the design of CHIP in such territory; and 
(8) other information regarding the carrying 
out of Medicaid and CHIP in the territory that is 
published on such internet site with respect to car-
rying out Medicaid and CHIP in each State and the 
District of Columbia. 
(b) DEFINITIONS.—In this section: 
(1) CHIP.—The term ‘‘CHIP’’ means the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act. 
(2) MEDICAID.—The term ‘‘Medicaid’’ means 
the Medicaid program under title XIX of the Social 
Security Act. 
(3) TERRITORY.—The term ‘‘territory of the 
United States’’ includes Puerto Rico, the Virgin Is-
lands of the United States, Guam, the Northern 
Mariana Islands, and American Samoa. 
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SEC. 302. REPORT ON EXCLUSION OF TERRITORIES FROM 
EXCHANGES. 
(a) IN GENERAL.—Not later than February 1, 2024, 
the Secretary of Health and Human Services shall submit 
to Congress a report that details the adverse impacts in 
each territory from the practical exclusion of the terri-
tories from the provisions of part II of subtitle D of title 
I of the Patient Protection and Affordable Care Act inso-
far as such provisions provide for the establishment of an 
American Health Benefit Exchange or the administration 
of a federally facilitated Exchange in each State and in 
the District of Columbia for the purpose of making health 
insurance more affordable and accessible for individuals 
and small businesses. 
(b) INFORMATION IN REPORT.—The report shall in-
clude information on the following: 
(1) An estimate of the total number of unin-
sured and underinsured individuals residing in each 
territory with respect to health insurance coverage. 
(2) A description of the number of health insur-
ance issuers in each territory and the health insur-
ance plans these issuers offer. 
(3) An estimate of the number of individuals re-
siding in each territory who are denied premium and 
cost-sharing assistance that would otherwise be 
available to them for obtaining health insurance cov-
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erage through an Exchange if they resided in one of 
the 50 States or in the District of Columbia. 
(4) An estimate of the amount of Federal as-
sistance described in paragraph (3) that is not being 
made available to residents of each territory. 
(5) An estimate of the number of small employ-
ers in each territory that would be eligible to pur-
chase health insurance coverage through a Small 
Business Health Options Program (SHOP) Market-
place that would operate as part of an Exchange if 
the employers were in one of the 50 States or in the 
District of Columbia. 
SEC. 303. ACCESS TO COVERAGE FOR INDIVIDUALS IN CER-
TAIN AREAS WITHOUT ANY AVAILABLE EX-
CHANGE PLANS. 
Part 2 of subtitle D of title I of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 18031 et seq.) 
is amended by adding at the end the following: 
‘‘SEC. 1314. ACCESS TO COVERAGE FOR INDIVIDUALS IN 
CERTAIN AREAS WITHOUT ANY AVAILABLE 
EXCHANGE PLANS. 
‘‘(a) IN GENERAL.— 
‘‘(1) COVERAGE
THROUGH
DC
EXCHANGE.— 
Not later than 3 months after the date of enactment 
of this section, the Secretary, in consultation with 
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the Secretary of the Treasury and the Director of 
the Office of Personnel Management, shall establish 
a mechanism to ensure that, for any plan year be-
ginning on or after the date described in subsection 
(c), any individual described in paragraph (2) has 
access to health insurance coverage which is at least 
as broad as the coverage available to Members of 
Congress and congressional staff (as defined in sec-
tion 1312(d)(3)(D)) through the Exchange operating 
in the District of Columbia. Such individuals shall 
be eligible for any premium tax credit under section 
36B of the Internal Revenue Code of 1986, reduced 
cost sharing under section 1402, and advance deter-
mination and payment of such credits or such reduc-
tions under section 1412 to be administered by the 
Secretary, in consultation with the Secretary of the 
Treasury and the Director of the Office of Personnel 
Management. The District of Columbia, its resi-
dents, and small businesses shall be held harmless 
from any increased costs resulting from the enact-
ment of this section. 
‘‘(2) INDIVIDUAL
DESCRIBED.—An individual 
described in this paragraph is any individual who— 
‘‘(A) is not eligible to enroll in an em-
ployer-sponsored health plan (excluding such a 
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plan that would not be considered minimum es-
sential coverage due to the application of sub-
paragraph (C) of section 36B(c)(2) of the In-
ternal Revenue Code of 1986 if such subpara-
graph applied to such plan); and 
‘‘(B) is a bona fide resident of any posses-
sion of the United States (as determined under 
section 937(a) of such Code) in which the Sec-
retary certifies that no qualified health plan is 
offered through an Exchange established under 
this title. 
‘‘(3) POSSESSION OF THE UNITED STATES.— 
For purposes of this section, the term ‘possession of 
the United States’ shall include such possessions as 
are specified in section 937(a)(1) of the Internal 
Revenue Code of 1986. 
‘‘(b) TREATMENT OF POSSESSIONS.— 
‘‘(1) PAYMENTS TO POSSESSIONS.— 
‘‘(A) MIRROR
CODE
POSSESSION.—The 
Secretary of the Treasury shall periodically (but 
not less frequently than annually) pay to each 
possession of the United States with a mirror 
code tax system amounts equal to the loss to 
that possession by reason of the application of 
this section (determined without regard to para-
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graph (2)) with respect to taxable years begin-
ning after the date described in subsection (c). 
Such amounts shall be determined by the Sec-
retary of the Treasury based on information 
provided by the government of the respective 
possession. 
‘‘(B) OTHER
POSSESSIONS.—The Sec-
retary of the Treasury shall periodically (but 
not less frequently than annually) pay to each 
possession of the United States which does not 
have a mirror code tax system amounts esti-
mated by the Secretary of the Treasury as 
being equal to the aggregate benefits that would 
have been provided to residents of such posses-
sion by reason of the application of this section 
for any taxable years beginning after the date 
described in subsection (c) if a mirror code tax 
system had been in effect in such possession. 
The preceding sentence shall not apply with re-
spect to any possession of the United States un-
less such possession has a plan, which has been 
approved by the Secretary of the Treasury, 
under which such possession will promptly dis-
tribute such payments to the residents of such 
possession. 
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